Purpose: Spinal epidural hematoma (EDH) is a rare condition requiring an urgent diagnosis and management. We describe here the clinical features, magnetic resonance image (MRI) findings, and outcomes of surgery in six patients with spinal EDH. Methods: We retrospectively analyzed six patients who un...
Purpose: Spinal epidural hematoma (EDH) is a rare condition requiring an urgent diagnosis and management. We describe here the clinical features, magnetic resonance image (MRI) findings, and outcomes of surgery in six patients with spinal EDH. Methods: We retrospectively analyzed six patients who underwent surgery for spinal EDH between April 2004 and May 2010. Preoperative MRI findings within 48 hours of symptom occurrence were analyzed for cord compression, extent of EDH, and presence of vascular abnormalities. Pre- and postoperative neurological status was also assessed comparatively. Results: Our six patients consisted of three men and three women, with a mean age of 70 years (range: 54-88 years), who presented with the back pain or motor weakness. The mean follow-up period was 34 months (range: 2-72 months). Two patients had cardiovascular disease and were taking warfarin, but the others had no history of medical comorbidity. Those two patients taking warfarin had a history of trauma, another one experienced symptoms during a strenuous effort, and the others developed spontaneously. Before surgery, motor power was grade III in three patients, grade 0 in two patients, and normal in one patient. Preoperative MRI showed no vascular abnormalities except for the EDH in any patient. At the last follow-up, all those five patients with motor weakness showed neurological improvement compared to their preoperative status. There were no complications related to surgery. All six patients were able to ambulate with or without an assistive device. Conclusion: Spinal EDH can occur in patients without trauma, bleeding diathesis, or combined vascular pathology. The surgical outcomes of spinal EDH seem to be satisfactory, even in quadriplegic patients.
Purpose: Spinal epidural hematoma (EDH) is a rare condition requiring an urgent diagnosis and management. We describe here the clinical features, magnetic resonance image (MRI) findings, and outcomes of surgery in six patients with spinal EDH. Methods: We retrospectively analyzed six patients who underwent surgery for spinal EDH between April 2004 and May 2010. Preoperative MRI findings within 48 hours of symptom occurrence were analyzed for cord compression, extent of EDH, and presence of vascular abnormalities. Pre- and postoperative neurological status was also assessed comparatively. Results: Our six patients consisted of three men and three women, with a mean age of 70 years (range: 54-88 years), who presented with the back pain or motor weakness. The mean follow-up period was 34 months (range: 2-72 months). Two patients had cardiovascular disease and were taking warfarin, but the others had no history of medical comorbidity. Those two patients taking warfarin had a history of trauma, another one experienced symptoms during a strenuous effort, and the others developed spontaneously. Before surgery, motor power was grade III in three patients, grade 0 in two patients, and normal in one patient. Preoperative MRI showed no vascular abnormalities except for the EDH in any patient. At the last follow-up, all those five patients with motor weakness showed neurological improvement compared to their preoperative status. There were no complications related to surgery. All six patients were able to ambulate with or without an assistive device. Conclusion: Spinal EDH can occur in patients without trauma, bleeding diathesis, or combined vascular pathology. The surgical outcomes of spinal EDH seem to be satisfactory, even in quadriplegic patients.
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제안 방법
We retrospectively analyzed six patients who underwent surgery for spinal EDH between April 2004 and May 2010. Clinical characteristics of the patients were reviewed and preoperative MRI findings within 48 hours of symptom occurrence were analyzed for evidence of cord compression, extent of EDH, and presence of vascular abnormalities. Pre- and postoperative neurological status was assessed comparatively.
대상 데이터
A 54-year-old man visited the hospital with acute severe back pain developed during a strenuous exertion. He had no neurological deficits and history of medication.
A 70-year-old woman was admitted to the hospital due to the back pain and paraparesis of grade III developed after a minor car accident 48 hours before.
An 82-year-old man was admitted due to paraplegia occurred within 24 hours.
An 88-year-old woman visited the hospital with right hemiparesis of grade III and neck pain that had occurred 3 hours before. Her symptoms developed spontaneously without any trauma and she had no history of comorbidity or medication.
Our six patients consisted of three men and three women, with a mean age of 70 years (range: 54-88 years), who presented with the back pain or motor weakness. The mean follow-up period was 34 months (range: 2-72 months).
성능/효과
3% of patients with complete deficit.(3) Our two patients with paraplegia showed good clinical outcome.
Factors associated with good prognosis include a short interval from symptom onset to surgery, with patients who undergo evacuation of the hematoma within 24 hours having good neurological outcomes.(3) Surgical decompression within 36 hours in patients with complete sensorimotor loss, and within 48 hours in patients with incomplete deficits, has been associated with significantly better outcomes than surgical decompression performed after this time.(19) Although a rapid onset of motor deficits has been reported to result in unfavorable outcomes, others have found no association between functional outcome and the speed of neurological deterioration.
참고문헌 (19)
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