Research Article: Two cases of spontaneous cervical epidural hematoma without back or neck pain in elderly Japanese men

Date Published: October 24, 2017

Publisher: John Wiley and Sons Inc.

Author(s): Takashi Hongo, Kenichi Iseda, Midori Tsuchiya, Mototaka Inaba, Satoshi Nozaki, Kenji Takahashi, Masaaki Nakajima, Toshifumi Fujiwara.

http://doi.org/10.1002/ams2.317

Abstract

Spontaneous spinal epidural hematoma (SSEH) is an uncommon disease. Most SSEH cases involve back and/or neck pain. We report the cases of two men who experienced SSEH with dysstasia but without back or neck pain.

This study presents two cases involving elderly Japanese men who visited an emergency department because of sudden dysstasia without back or neck pain. The results of the neurological examinations revealed ataxic gait. Cervical spinal epidural hematomas were observed by computed tomography and magnetic resonance imaging. One patient underwent hematoma removal and decompression by corpectomy, whereas the other patient received conservative treatment and observation. The patients were discharged without sequelae.

Spinal epidural hematomas are difficult to diagnose, and a delayed diagnosis can adversely affect the patient’s quality of life. These hematomas should be considered in the differential diagnosis of cerebrovascular diseases.

Partial Text

Spontaneous spinal epidural hematoma (SSEH) is an uncommon disease that is characterized by an acute onset of quadriplegia or paraplegia. Previous case reports have indicated that almost 90% of SSEH cases involve back and/or neck pain.1 We report the cases of two elderly Japanese men who experienced spontaneous cervical epidural hematomas with dysstasia but without back or neck pain.

A SPINAL EPIDURAL hematoma is a rare but disabling disease, and SSEH is frequently described as a hematoma occurring in the absence of trauma or iatrogenic procedure. The cause of spinal epidural hematoma in 40–50% of cases is not known.2 The causes of SSEH, such as increased bleeding tendency with the use of various medications,3 blood dyscrasia,4 direct or indirect spinal trauma,5 and hypertension,6 have been discussed in published works. However, the mechanism of spinal epidural hematoma is not clear. Most researchers have asserted that spinal epidural hematoma arises from epidural venous plexus in the spinal space.7 The fluctuations in intrathoracic and intra‐abdominal pressures after exercise or other maneuvers induce rupture of a delicate vein in the valveless epidural plexus.7 In case 1, no specific source of bleeding, such as vascular malformation or tumor, was observed during surgery. The increased venous pressure caused by cervical movement, high blood pressure, and antiplatelet medication induced hematoma. In case 2, the only risk factor for SSEH was high blood pressure. The locations of SSEH appear to have a bimodal distribution with peaks observed at C6 and T12.8 These SSEH lesions are usually located dorsal to the spinal cord.2 Spontaneous spinal epidural hematoma generally develop in individuals between the ages of 50 and 80 years.9

We reported two cases of SSEH in elderly Japanese men with dysstasia only and without back or neck pain. The findings of this study indicate that SSEH should be considered in the differential diagnosis of similar cases, especially in Japan.

Approval of the research protocol: Yes.

 

Source:

http://doi.org/10.1002/ams2.317

 

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