Spontaneous spinal epidural hematomas—Time is running out!

Spontaneous spinal epidural hematoma (SSEH) is the rarest cause of spinal cord compression, causing paraparesis or quadriparesis. They account for less than 1% (0.1 patients per 100,000 patients per year) of all spinal canal space-occupying lesions, thus resulting in a paucity of literature. Here, we report three cases of SSEH; all had a neurological deficit on presentation and were surgically managed with decompressive laminectomy and evacuation of the hematoma.

Of the three patients, one had a history of coronary artery disease and was on anticoagulants. In the remaining two, no cause could be identified. The hematoma was located at the thoracic region in 2 patients and at the cervical in one. Hematoma were located dorsal to cord in 2 patients and ventral in one. Two cases presented within 30 h of the onset of symptoms with the ASIA (American Spinal Injury Association) impairment scale (AIS) A and B neurology. Both showed a complete recovery during their latest follow-up. However, one case presented after 2 days with AIS A neurology and improved to AIS B post-operatively at 30 months follow-up.

The myriad of symptoms and the need for an MRI for diagnosis have made SSEH difficult to diagnose clinically. Unlike other spinal pathologies where the severity of the preoperative neurological deficit is the best predictor of prognosis, in SSEH, time is the best predictor of prognosis. Our series highlights the fact that irrespective of the severity of the preoperative neurological deficit, timely diagnosis and early, adequate decompression surgery are essential for complete neurological recovery.