Spontaneous spinal epidural hematoma: Magnetic resonance imaging for diagnosis and patient management in two cases

摘要

As far as operative indications for spinal epidural hematoma are concerned, symptoms and duration from onset are thought to be quite important. However, magnetic resonance imaging (MRI) intensity of the hematoma could be a key factor in determining the need for operative intervention. Here, we discuss two cases of spinal epidural hematoma. One was the operative case of a 71-year-old man who presented with left leg paresis. On the initial spinal MRI, a low-iso T1-weighted image (WI) showed a slight high-iso T2WI heterogenous intensity and a thick epidural mass that had compressed the spinal cord dorsolaterally from the C7 to T5 levels. The mass was diagnosed as a cervicothoracic epidural hematoma in the acute phase as coagulation seemed to be starting. Five hours after presentation, his symptoms evolved into complete paraplegia; therefore, decompression laminectomy and hematoma evacuation was performed. The other case was that of a 68-year-old woman with severe neck pain. The initial MRI demonstrated a T1WI iso, T2WI high homogenous intensity epidural mass from the C2 to T4 levels. A spinal epidural hematoma in the hyperacute phase was diagonesd. Conservative treatment was recommended, and her symptoms and hematoma almost disappeared within three days. When coagulation or organization of the hematoma has not started, its absorption might be expected at an early stage. MRI appearances, including hematoma intensity, combined with simultaneous clinical information might be very important for surgical decision making and predicting prognosis in cases of spinal epidural hematomas.