High blood pressure and the spontaneous spinal epidural hematoma: the misconception about their correlation

摘要

We read with great interest the recent Letter to the Editor from Spengos et al. about the report by Hsieh et al. of a case of acute spontaneous cervical epidural hematoma suffering from high blood pressure at the time of presentation at the emergency department because of sudden neck pain and a progressive right limb weakness. Spengos et al. recall their publication of a similar case with a spontaneous spinal epidural hematoma (SSEH) at C4-7, suffering from both hypertension and a Brown-Sequard syndrome after acute neck pain. No apparent cause of the hematoma was found. On the basis of the fact that both patients shared a series of commoncharacteristics , Spengos et al. state that (untreated) hypertension should be considered the cause of bleeding.As SSEH is a very rare disorder, knowledge of this entity is limited and (large) series from single institutions are missing. As a result, much has been speculated about its etiology. As possible etiological factors, minor trauma, sneezing, whooping cough, voiding, vomiting, lifting, pregnancy, hypertension, atherosclerosis, anticoagulants and bleeding diathesis have been mentioned . As the possible source of hemorrhage, a vascular malformation, a spinal epidural artery or a spinal epidural venous structure have been proposed .