Acute Spontaneous Spinal Epidural Hematomas

• Published in: American journal of neuroradiology : AJNR Vol. 20; no. 7; pp. 1365 - 1372
• Main Authors: Fukui, Melanie B, Swarnkar, Amar S, Williams, Robert L
• Format: Journal Article
• Language: English
• Published: Oak Brook, IL Am Soc Neuroradiology 01-08-1999; American Society of Neuroradiology
• Subjects: Acute Disease; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Female; Hematoma, Epidural, Cranial - complications; Hematoma, Epidural, Cranial - diagnosis; Hematoma, Epidural, Cranial - therapy; Humans; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Neurology; Spinal Cord - pathology; Spinal Cord Compression - diagnosis; Spinal Cord Compression - etiology; Spinal Diseases - diagnosis; Spinal Diseases - therapy; Spine; Time Factors; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system; Human; Nervous system diseases; Spinal cord; Acute; Central nervous system; Cardiovascular disease; Exploration; Nuclear magnetic resonance imaging; Vascular disease; Case study; Extradural; Central nervous system disease; Hematoma; Medical imagery; Spinal cord disease
• ISSN: 0195-6108; 1936-959X

Although previous reports have characterized MR imaging features of spinal epidural hematomas (EDH), few cases have been reported during the acute or hyperacute phase within the first 48 hours. Our goal in this investigation was to correlate the MR imaging features of acute (< or =48 hours) spontaneous EDH with clinical management and outcome.
Eight patients with acute spontaneous EDH (five men and three women; age range, 31-81 years) underwent MR imaging at 1.5 T (T1-weighted, n = 8; T1-weighted after the administration of 0.1 mmol/kg contrast material, n = 6; T2-weighted, n = 8; and T2-weighted, n = 4). The interval from symptom onset to hospital admission ranged from immediate to 5 days. Two neuroradiologists reviewed the MR images for signal characteristics, contrast enhancement, and cord compression. Treatment and clinical outcome were correlated with the imaging findings.
The EDH were located in the cervical (n = 3), cervicothoracic (n = 2), thoracolumbar (n = 2), and lumbar (n = 1) regions. On T1-weighted images, the signal intensity of the EDH was isointense to spinal cord in five cases, hyperintense in two cases, and hypointense in one case and did not correlate with time to imaging. Isointensity on T1-weighted images persisted for 5 days in one case. On T2-weighted images, all EDHs were hyperintense with focal, heterogeneous hypointensity. Cord compression was severe in six patients, moderate in one patient, and minimal in one patient. Four cases were treated conservatively with complete resolution or improvement of symptoms within 1 to 3 weeks.
MR imaging findings were useful in establishing the diagnosis of EDH but did not influence management or predict outcome in this series. Heterogeneous hyperintensity to cord with focal hypointensity on T2-weighted images should suggest the diagnosis of acute spinal EDH. Severity of neurologic impairment had the greatest impact on management and outcome. Nonoperative treatment may be successful in cases with minimal neurologic deficits, despite cord compression revealed by MR imaging.