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Spinal Subdural or Epidural Hematoma

By

Michael Rubin

, MDCM, New York Presbyterian Hospital-Cornell Medical Center

Last full review/revision May 2021| Content last modified May 2021
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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.

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 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.

Diagnosis

  • MRI

Hematoma is suspected in patients with symptoms and signs of acute, nontraumatic spinal cord compression or sudden, unexplained lower extremity paresis, particularly if a possible cause (eg, trauma, bleeding diathesis) is present.

Diagnosis of a spinal subdural or epidural hematoma is by MRI or, if MRI is not immediately available, by CT myelography.

Treatment

  • Drainage

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 subcutaneously and fresh frozen plasma as needed to normalize the INR (international normalized ratio). Patients with thrombocytopenia are given platelets.

Key Points

  • Suspect spinal subdural or epidural hematoma in patients with local or radicular back pain and percussion tenderness or sudden, unexplained lower-extremity paresis, particularly if a possible cause (eg, trauma, bleeding diathesis) is present.

  • Diagnose using MRI or, if MRI is not immediately available, CT myelography.

  • Immediately drain the hematoma surgically.

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