Spinal Subdural or Epidural Hematoma
A spinal subdural or epidural hematoma is an accumulation of blood in the subdural or epidural space that can mechanically compress the spinal cord. Diagnosis is by MRI or, if not immediately available, by CT myelography. Treatment is with immediate surgical drainage.
(See also Overview of Spinal Cord Disorders.)
Spinal subdural or epidural hematoma (usually thoracic or lumbar) is rare but may result from back trauma, anticoagulant or thrombolytic therapy, or, in patients with bleeding diatheses, lumbar puncture.
Symptoms of a spinal subdural or epidural hematoma begin with local or radicular back pain and percussion tenderness; they are often severe. Spinal cord compression may develop; compression of lumbar spinal roots may cause cauda equina syndrome and lower extremity paresis. Deficits progress over minutes to hours.
Treatment of a spinal subdural or epidural hematoma is immediate surgical drainage.
Patients taking coumarin anticoagulants are given phytonadione (vitamin K1) 2.5 to 10 mg sc and fresh frozen plasma as needed to normalize INR. Patients with thrombocytopenia are given platelets.
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