Acute spinal epidural hematoma: A case report and review of the literature

Spinal epidural hematoma (SEH) is a rare but a significant cause of spinal cord compression and neurologic deficits. Its etiology is usually unknown and requires emergency intervention. The present study aims to review the clinical significance, treatment strategies and clinical outcomes of traumatic SEH with a rare case presentation. Our patient was a 42-year-old female who presented with back pain and loss of sensation and strength in the legs. The patient did not have any disease and did not use anticoagulant drugs. The patient developed numbness in her legs half an hour after having a traditional back walking massage due to occasional back pain. She was paraplegic and anesthetic when seen in our clinic. Thoracic computed tomography (CT) and magnetic resonance imaging (MRI) revealed posterior epidural hemorrhage at Th3-Th4 levels. In the 12th hour, the hematoma was evacuated by an emergency decompressive hemilaminectomy. At the postoperative 24th hour, the patient had symptomatic improvement, and in the sixth month, the patient was mobilized with support. SEH is a rare condition that should be considered in patients with sudden onset of back pain and extremity weakness. Although the gold standard diagnostic tool is MRI, CT is often sufficient to avoid delayed surgery. Immediate surgical decompression (laminectomy/hemilaminectomy) should be performed in cases diagnosed with SEH with neurological deficits.

Akut spinal epidural hematom: Olgu sunumu ve literatürün gözden geçirilmesi

Spinal epidural hematom (SEH) omurilik basýsý ve nörolojik defisit geliþiminin nadir fakat önemli bir sebebidir. Etyoloji genellikle bilinmez ve acil cerrahi müdahele gerektirir. Bu çalýþmada amacýmýz, nadir bir olgu sunumu ile travmatik SEH’nin klinik önemi, tedavi stratejileri ve tedavi sonrasý son durumlarýný gözden geçirmektir. Olgumuz 42 yaþýnda kadýn hasta olup, sýrt aðrýsý, bacaklarda his ve kuvvet kaybý ile baþvurdu. Hastanýn herhangi bir hastalýðý yoktu ve antikoagülan ilaç kullanýmýyordu. Hasta, ara sýra olan sýrt aðrýsýndan dolayý geleneksel sýrt masajý yaptýrdýktan yarým saat sonra bacaklarýnda uyuþma ve kuvvet kaybý ile baþvurdu. Hasta kliniðimizde görüldüðünde paraplejik ve T4 altýnda anestezik idi. Torakal bilgisayarlý tomografi (BT) ve manyetik rezonans görüntülerde (MRG) T3-T4 seviyelerinde posteriyor epidural akut hemoraji izlendi. On ikinci saatte, acil dekompresif hemilaminektomi iþlemi yapýlarak hematom boþaltýldý. Ameliyat sonrasý 24. saatte hastada semptomatik iyileþme görüldü ve altýncý ayda hasta destekle mobilize oluyordu. SEH, ani baþlayan sýrt aðrýsý ve ekstremite güçsüzlüðü olan olgularda akla gelmesi gereken nadir bir durumdur. Tanýda altýn standart inceleme MRG olmakla beraber, cerrahi müdahaleyi geciktirmemek için BT çoðu zaman yeterli olabilmektedir. Tanýsý koyulan ve nörolojik defisiti olan olgularda acil cerrahi dekompresyon (laminektomi/hemilaminektomi) yapýlmalýdýr.