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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2017; 75(01): 76
DOI: 10.1590/0004-282X20160177
Images in Neurology

Sudden back pain as clinical presentation of spontaneous spinal epidural hematoma

Dor lombar súbita como apresentação clínica de hematoma epidural espinhal espontâneo
Plínio Duarte Mendes
1   Biocor Instituto, Departamento de Especialidades Cirúrgicas, Divisão de Neurocirurgia, Nova Lima MG, Brasil
,
Clayton Lucas da Silva Lopes
1   Biocor Instituto, Departamento de Especialidades Cirúrgicas, Divisão de Neurocirurgia, Nova Lima MG, Brasil
,
Guilherme de Sousa Baptista
2   Hospital São João de Deus, Divisão de Neurocirurgia, Divinópolis MG, Brasil
,
Paulo Mallard Scaldaferri
3   Hospital Unimed, Divisão de Neurocirurgia, Belo Horizonte MG, Brasil
,
Gustavo Agra Cariri
1   Biocor Instituto, Departamento de Especialidades Cirúrgicas, Divisão de Neurocirurgia, Nova Lima MG, Brasil
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An 89-year-old woman admitted to the Emergency Care Department with reported back pain nine days earlier that started suddenly when sitting. This subsequently evolved into progressive paraparesis (Frankel D). An MRI of the lumbosacral spine revealed an extensive lumbar epidural hematoma ([Figure]). The patient underwent decompressive laminectomy of T12-L1.

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Figure Sagittal and axial sequence. Epidural hematoma T5-T6 to L1-L2, more importantly in the T9-T10 to L1-L2 segment, which shows the compressive effect on the roots of the cauda equina, the thoracic spine and medullary conus. Bottom right: Intraoperative photograph showing the epidural hematoma after laminectomy (white arrow).

Spontaneous epidural hematoma is a rare disease, most often involving the thoracolumbar region, followed by the cervical region[1]. Non-traumatic causes include hypertension, coagulopathies, use of anticoagulants, arteriovenous abnormalities, tumors of the backbone and lumbar puncture. In approximately 40% of cases, the etiology cannot be determined. Typically, pain is the root of the acute onset, accompanied by neurological deficit[1],[2].


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Conflict of interest:

There is no conflict of interest to declare.

  • References

  • 1 Liao CC, Hsieh PC, Lin TK, Lin CL, Lo YL, Lee SC. Surgical treatment of spontaneous spinal epidural hematoma: a 5-year experience. J Neurosurg Spine. 2009;11(4):480-6. doi:10.3171/2009.4.SPINE08904
  • 2 Ferreira ROMF, Rocha FJ, Barros JA, Fonseca AVB, Paiva PR. [Spontaneous epidural hematoma of the lumbar region: report of two cases]. Arq Neuropsiquiatr. 1980;38(3):313-6. Portuguese. doi:10.1590/S0004-282X1980000300014

Address for correspondence

Plínio Duarte Mendes
Departamento de Especialidades Cirúrgicas, Serviço de Neurocirurgia, Biocor Instituto; R. da Paisagem, 280; 34000-000 Nova Lima MG
Brasil   

Publication History

Received: 25 July 2016

Accepted: 09 September 2016

Article published online:
06 September 2023

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  • References

  • 1 Liao CC, Hsieh PC, Lin TK, Lin CL, Lo YL, Lee SC. Surgical treatment of spontaneous spinal epidural hematoma: a 5-year experience. J Neurosurg Spine. 2009;11(4):480-6. doi:10.3171/2009.4.SPINE08904
  • 2 Ferreira ROMF, Rocha FJ, Barros JA, Fonseca AVB, Paiva PR. [Spontaneous epidural hematoma of the lumbar region: report of two cases]. Arq Neuropsiquiatr. 1980;38(3):313-6. Portuguese. doi:10.1590/S0004-282X1980000300014

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Zoom Image
Figure Sagittal and axial sequence. Epidural hematoma T5-T6 to L1-L2, more importantly in the T9-T10 to L1-L2 segment, which shows the compressive effect on the roots of the cauda equina, the thoracic spine and medullary conus. Bottom right: Intraoperative photograph showing the epidural hematoma after laminectomy (white arrow).