A spinal subdural or epidural hematoma is an accumulation of blood in the subdural or epidural space that can mechanically compress the spinal cord.

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 and Signs

Symptoms 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.

Diagnosis

• MRI

Hematoma is suspected in patients with acute, nontraumatic spinal cord compression or sudden, unexplained lower extremity paresis, particularly if a possible cause (eg, trauma, bleeding diathesis) is present. Diagnosis is by MRI or, if MRI is not immediately available, by CT myelography.

Treatment

• Drainage

Treatment 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 (see Transfusion Medicine: Platelets).

Last full review/revision November 2012 by Michael Rubin, MDCM