1/4. Spontaneous spinal epidural hematoma in a pregnant patient.Spontaneous spinal epidural hematoma is a rare occurrence during pregnancy with only five cases described in the literature since 1900. Even in the general population, the frequency of spontaneous spinal epidural hematoma is extremely low and the etiology unclear. Several theories exist for the cause of spontaneous spinal epidural hematoma, however, none has gained uniform acceptance. A case of spontaneous spinal epidural hematoma during pregnancy in a 27-year-old, gravida 2, para 1, female at term with 36 hours duration of both paresthesia and progressive weakness of the lower extremities is presented. In addition, all previous known cases are summarized, including outcome. We hypothesize that the cause of spontaneous spinal epidural hematoma is multifactorial, and pregnancy-induced structural changes in arterial walls and hemodynamic changes may play a role. In addition, we postulate that the origin of the bleeding is arterial, rather then venous. Lastly, the symptoms, diagnosis, and management of spontaneous spinal epidural hematoma during pregnancy are discussed.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
2/4. Spontaneous spinal epidural hematoma during pregnancy: case report and literature review.OBJECTIVE AND IMPORTANCE: Spinal epidural hematoma is a rare cause of spinal cord compression and acute para- or quadriplegia. Traumatic spinal epidural hematomas are usually seen in older men with a history of ankylosing spondylitis and vertebral fracture. Spontaneous spinal epidural hematomas are commonly associated with coagulopathies, tumors, or vascular malformations. There have been only five previously published case reports in the English-language literature of spontaneous spinal epidural hematomas in conjunction with pregnancy. CLINICAL PRESENTATION: We present the case of a 24-year-old woman at 20 weeks' gestation who presented to our service with a spontaneous cervicothoracic spinal epidural hematoma and complete quadriplegia. INTERVENTION: The patient was taken to the operating room for urgent surgical decompression and evacuation of the spinal epidural hematoma. CONCLUSION: The patient made a complete neurological recovery in long-term follow-up. In the meantime, she carried her pregnancy to term and gave birth to a healthy baby. Therefore, we advocate aggressive and early surgical intervention, similar to the five previously reported cases in the English-language literature, in the case of a spinal epidural hematoma causing cord compression and devastating neurological deficit in a pregnant woman.- - - - - - - - - - ranking = 1.5keywords = pregnancy (Clic here for more details about this article) |
3/4. Spontaneous epidural hematoma of the spine in pregnancy.Spontaneous spinal epidural hematomas are uncommon. Progressive neurologic deficits that are associated with epidural hematomas can develop rapidly and require prompt treatment. We present a case of spontaneous epidural hematoma of the thoracic spine that complicated a term pregnancy.- - - - - - - - - - ranking = 1.25keywords = pregnancy (Clic here for more details about this article) |
4/4. Spontaneous spinal epidural hematoma during pregnancy.BACKGROUND: Spontaneous spinal epidural hematoma is a rare phenomenon that has no distinct etiology. Spontaneous spinal epidural hematoma (SSEH) during pregnancy is extremely rare. We present what we believe to be the fifth reported case of spontaneous spinal epidural hematoma associated with pregnancy in the English literature. methods: A 31-year-old female presented with acute onset of paraplegia at 32 weeks of pregnancy. The patient had a T2 sensory level and complete paralysis of all lower extremity motor groups. magnetic resonance imaging of the thoracic spine showed an acute epidural hematoma posterior to the thoracic spinal cord between the second and fourth thoracic vertebrae. RESULTS: The patient was taken to the operating room were her child was delivered by caesarean section. She then underwent a posterior laminectomy and evacuation of a spinal epidural hematoma. Follow-up selective spinal angiography was negative for any vascular malformation. The patient gradually recovered lower extremity function and was independently ambulating at six month follow-up. Voluntary bowel and bladder function returned within four months but twice daily intermittent catheterization remained necessary for excessive post-void residual urine. CONCLUSIONS: Spontaneous spinal epidural hematoma in pregnancy is a rare phenomenon. It is postulated that elevated venous pressure associated with pregnancy may be a contributing factor. In the reported cases of SSEH in pregnancy most patients presented with acute symptoms, thoracic location and profound neurological deficits but, with prompt surgical treatment, generally had good long term recovery.- - - - - - - - - - ranking = 2.5keywords = pregnancy (Clic here for more details about this article) |