Date Published: July 28, 2011
Publisher: SAGE-Hindawi Access to Research
Author(s): Kinya Nakanishi, Naoki Nakano, Takuya Uchiyama, Amami Kato.
We report three cases of spontaneous spinal epidural hematoma (SSEH) with hemiparesis. The first patient was a 73-year-old woman who presented with left hemiparesis, neck pain, and left shoulder pain. A cervical MRI scan revealed a left posterolateral epidural hematoma at the C3–C6 level. The condition of the patient improved after laminectomy and evacuation of the epidural hematoma. The second patient was a 62-year-old man who presented with right hemiparesis and neck pain. A cervical MRI scan revealed a right posterolateral dominant epidural hematoma at the C6-T1 level. The condition of the patient improved after laminectomy and evacuation of the epidural hematoma. The third patient was a 60-year-old woman who presented with left hemiparesis and neck pain. A cervical MRI scan revealed a left posterolateral epidural hematoma at the C2–C4 level. The condition of the patient improved with conservative treatment. The classical clinical presentation of SSEH is acute onset of severe irradiating back pain followed by progression to paralysis, whereas SSEH with hemiparesis is less common. Our cases suggest that acute cervical spinal epidural hematoma should be considered as a differential diagnosis in patients presenting with clinical symptoms of sudden neck pain and radicular pain with progression to hemiparesis.
Spontaneous spinal epidural hematoma (SSEH) is uncommon, but the number of cases has increased with clarification of the clinical presentation of the condition using radiographic imaging. Here, we report three cases of SSEH with hemiparesis, which is uncommon compared to the classical presentation of SSEH as acute onset of severe irradiating back pain followed by paralysis.
Spinal epidural hematoma was first described by Jackson  in 1869. The yearly incidence is now thought to be approximately 0.1 per 100,000 people , and the condition is no longer considered to be rare due to increased diagnosis by MRI. As possible etiology factors, minor trauma, sneezing, whooping cough, voiding, vomiting, lifting, pregnancy, hypertension, atherosclerosis, anticoagulants, and bleeding diathesis have been mentioned [3, 4]. Analysis of a large series of SSEH that were reported in the international medical literature suggested a correlation between SSEH and coexistence of arterial hypertension . These factors may cause secondary spinal epidural hematoma with a clear cause (60%) or spontaneous spinal epidural hematoma (SSEH) of unclear cause (40%) [3, 5, 6]. SSEH tends to be more common in middle-aged or older patients, in males compared to females . The majority of SSEH are situated in the C5-Th2 area .