JBJS Case Connections—Spinal Epidural Hematoma: Rare, But Potentially Devastating

CCX O'Buzz Image.gifSpinal epidural hematoma is a rare condition. Because the etiology is often unclear and the medical history is frequently innocuous, a high index of suspicion is required in order to maximize the chances of a successful outcome.

This month’s “Case Connections” spotlights 4 cases of spinal epidural hematoma involving 2 elderly women, a male Olympic-caliber swimmer, and a preadolescent boy.

In the springboard case, from the March 22, 2017, edition of JBJS Case Connector, Yamaguchi et al. report on a 90-year-old woman with a history of transient ischemic attacks (TIAs) and combined aspirin-dipyridamole therapy in whom a large spontaneous spinal epidural hematoma (SSEH) developed rapidly after she shifted her position in bed. The authors concluded that their case emphasized that “early diagnosis of an SSEH and prompt surgical intervention can avoid catastrophic and permanent neurological deterioration and compromise.”

Three additional JBJS Case Connector case reports summarized in the article focus on:

Among the take-home points from this “Case Connections” article: MRI is the gold standard for the diagnosis of spinal epidural hematomas, and treatment typically involves operative decompression consisting of laminectomies and evacuation of the hematoma.

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