Two cases of vertex epidural hematomas are described to illustrate their unique diagnostic and treatment problems. Due to its specific location, a correct diagnosis of the intracranial hematoma was delayed in the first case. Quantitative analysis of the hematoma volume was performed in the second case. We would like to emphasize the usefulness of the magnetic resonance imaging and quantitative analysis of vertex epidural hematoma in choosing treatment options in such patients.
Adult ; Case Report ; Hematoma, Epidural/*diagnosis/surgery ; Human ; Magnetic Resonance Imaging ; Male

BACKGROUNDDespite low morbidity, acute or subacute spinal epidural hematoma may develop quickly with a high tendency to paralysis. The delay of diagnosis and therapy often leads to serious consequences. In this study we evaluated the effects of a series of methods for the diagnosis and treatment of the hematoma in 11 patients seen in our hospital.

METHODSOf the 11 patients (8 males and 3 females), 2 had the hematoma involving cervical segments, 2 cervico-thoracic, 4 thoracic, 1 thoraco-lumbar, and 2 lumbar. Three patients had quadriplegia, including one with central cord syndrome; another had Brown-Sequard's syndrome; and the other seven had paraplegia. Five patients were diagnosed at our hospitals within 3 - 48 hours after appearance of symptoms, and 6 patients were transferred from community hospitals within 21 - 106 hours after development of symptoms. Key dermal points, key muscles and the rectal sphincter were determined according to the American Spinal Injury Society Impairment Scales as scale A in two patients, B in 5 and C in 4. Emergency MRI in each patient confirmed that the dura mater was compressed in the spinal canal, with equal intensity or hyperintensity on T(1) weighted image and mixed hyperintensity on T(2) weighted image. Preventive and curative measures were taken preoperatively and emergency operation was performed in all patients. Open laminoplasty was done at the cervical and cervico-thoracic segments, laminectomy at the thoracic segments, laminectomy with pedicle screw fixation at the thoraco-lumbar and lumbar segments involving multiple levels, and double-sided laminectomy with the integrity of articular processes at the lumbar segments involving only a single level. During the operation, special attention was given to hematoma evacuation, hemostasis and drainage tube placement.

RESULTSNeither uncontrollable hemorrhage nor postoperative complications occurred. All patients were followed up for 1 - 6 years. A marked difference was noted between postoperative and preoperative scales (u = 3.66, P < 0.01). Most patients recovered after therapy, but the recovery of patients treated at our hospitals was superior to that of those transferred from community hospitals (t = 2.95, P < 0.05). Of the patients treated at our hospitals, 4 were cured and 1 was upgraded with scale from A to D, whereas none of those transferred from community hospitals recovered completely, even one remained scale C.

CONCLUSIONSPhysical examination plus MRI is essential to early diagnosis of acute or subacute spinal epidural hematoma. Preventive and curative measures including emergency operation are helpful to the recovery of patients' nerve function.

Acute Disease ; Adult ; Aged ; Female ; Follow-Up Studies ; Hematoma, Epidural, Spinal ; diagnosis ; surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged

We report a series of epidural hematomas which cause neurologic deterioration after spinal surgery, and have taken risk factors and prognostic factors into consideration. We retrospectively reviewed the database of 3720 cases of spine operation in a single institute over 7 years (1998 April-2005 July). Nine patients who demonstrated neurologic deterioration after surgery and required surgical decompression were identified. Factors postulated to increase the postoperative epidural hematoma and to improve neurologic outcome were investigated. The incidence of postoperative epidural hematoma was 0.24%. Operation sites were cervical 3 cases, thoracic 2 cases, and lumbar 4 cases. Their original diagnoses were tumor 3 cases, cervical stenosis 2 cases, lumbar stenosis 3 cases and herniated lumbar disc 1case. The symptoms of epidural hematomas were neurologic deterioration and pain. After decompression, clinical outcome revealed complete recovery in 3 cases (33.3%), incomplete recovery in 5 cases (55.6%) and no change in 1 case (11.1%). Factors increasing the risk of postoperative epidural hematoma were coagulopathy from medical illness or anticoagulation therapy (4 cases, 44.4%) and highly vascularized tumor (3 cases, 33.3%). The time interval to evacuation of complete recovery group (29.3 hours) was shorter than incomplete recovery group (66.3 hours). Patients with coagulopathy and highly vascularized tumor were more vulnerable to spinal epidural hematoma. The postoperative outcome was related to the preoperative neurological deficit and the time interval to the decompression.
Treatment Outcome ; Spinal Diseases/*surgery ; Risk Factors ; Retrospective Studies ; Postoperative Complications/diagnosis/*epidemiology ; Middle Aged ; Male ; Humans ; Hematoma, Epidural, Spinal/diagnosis/*epidemiology/*etiology ; Female ; Aged ; Adult

We report a series of epidural hematomas which cause neurologic deterioration after spinal surgery, and have taken risk factors and prognostic factors into consideration. We retrospectively reviewed the database of 3720 cases of spine operation in a single institute over 7 years (1998 April-2005 July). Nine patients who demonstrated neurologic deterioration after surgery and required surgical decompression were identified. Factors postulated to increase the postoperative epidural hematoma and to improve neurologic outcome were investigated. The incidence of postoperative epidural hematoma was 0.24%. Operation sites were cervical 3 cases, thoracic 2 cases, and lumbar 4 cases. Their original diagnoses were tumor 3 cases, cervical stenosis 2 cases, lumbar stenosis 3 cases and herniated lumbar disc 1case. The symptoms of epidural hematomas were neurologic deterioration and pain. After decompression, clinical outcome revealed complete recovery in 3 cases (33.3%), incomplete recovery in 5 cases (55.6%) and no change in 1 case (11.1%). Factors increasing the risk of postoperative epidural hematoma were coagulopathy from medical illness or anticoagulation therapy (4 cases, 44.4%) and highly vascularized tumor (3 cases, 33.3%). The time interval to evacuation of complete recovery group (29.3 hours) was shorter than incomplete recovery group (66.3 hours). Patients with coagulopathy and highly vascularized tumor were more vulnerable to spinal epidural hematoma. The postoperative outcome was related to the preoperative neurological deficit and the time interval to the decompression.
Treatment Outcome ; Spinal Diseases/*surgery ; Risk Factors ; Retrospective Studies ; Postoperative Complications/diagnosis/*epidemiology ; Middle Aged ; Male ; Humans ; Hematoma, Epidural, Spinal/diagnosis/*epidemiology/*etiology ; Female ; Aged ; Adult

OBJECTIVETo investigate early recognition and clinical evaluation of spontaneous spinal epidural hematoma (SSEH) and to analyze the factors related to prognosis.

METHODSNine patients with SSEH were include in current study. There were 7 men and 2 women with a mean age of 45.4 years (range, 18-83 years). Etiological factors were noted in 9 patients, 3 with hypertension, 2 with angioma, 2 with laminar osteoblastoma, 1 with neuroblastoma, and 1 with thrombolysis treatment. Six patients presented with acute onset of neck or back pain. Two patients initially presented with incomplete paralysis. One patient emerged with ascending bilateral lower extremity weakness and loss of sensation after thrombolysis treatment. Neurologic deficit was four as Frankel A, two as Frankel B, one as Frankel C and two as Frankel D. Evacuation of the hematoma was carried out in eight patients. One patient of thrombolysis treatment was treated conservatively because of loss of optimum for operation.

RESULTSEight hematomas were located in thoracic region, one was found in the cervicothoracic region. Mean extension was 3.7 segments (range, 2-8 segments). One patient died of severe pulmonary infection 50 days postoperatively. The average follow-up observation was 7. 5 months. Evaluation of the neurological function showed that 2 patients being classified as Frankel B, 1 as Frankel D and 4 patients as Frankel E. There was no improvement of neurological function in 1 patient with conservative treatment.

CONCLUSIONSThe keys to the early diagnosis of SSEH are the characteristic of clinical symptoms, and the lesion site, the extent of the lesion demonstrated by MRI. The prognosis is worse for SSEH with etiological factor of hypertension. Early diagnosis and surgical treatment might get better results for SSEH resulting from tumour.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Early Diagnosis ; Female ; Follow-Up Studies ; Hematoma, Epidural, Spinal ; diagnosis ; etiology ; surgery ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies

Recurrent disc herniation and postoperative fibrosis are the main disease entities causing failed back surgery syndrome (FBSS) and magnetic resonance (MR) imaging has become a major diagnostic modality in differentiating the two. To observe the variable entities of FBSS and their MR findings, we retrospectively analyzed 15 MR images in 12 patients. The causes of FBSS were as follows; normal (no organic cause), fibrosis, new or recurrent disc herniation, discitis, osteomyelitis, inflammation at operation site, epidural abscess, arachnoiditis, and hematoma. Except a case of hematoma, gadolinium enhancement scan was necessary and informative in the diagnosis of FBSS and MR imaging only was not enough in the diagnosis of arachnoiditis.
Arachnoid ; Arachnoiditis ; Diagnosis ; Discitis ; Epidural Abscess ; Failed Back Surgery Syndrome* ; Fibrosis ; Gadolinium ; Hematoma ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Osteomyelitis ; Retrospective Studies

Adolescent ; Brain Diseases ; diagnostic imaging ; Brain Neoplasms ; diagnostic imaging ; surgery ; Diagnosis, Differential ; Hematoma, Epidural, Cranial ; diagnostic imaging ; Hernia ; diagnostic imaging ; Humans ; Male ; Plasmacytoma ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed