ADRSupport Community  

Go Back   ADRSupport Community > General Discussion > ADR Frequently Asked Questions

ADR Frequently Asked Questions Find answers to commonly asked questions here. Please do not post comments here, but choose the appropriate forum to make comments on FAQs herein.


Reply
 
Thread Tools
  #1  
Old 03-09-2006, 02:40 PM
Alastair Alastair is offline
Senior Member
 
Join Date: Oct 2004
Posts: 2,391
Default

Discussion
The incidence of spinal epidural hematomas (SEH) is 0.1 per 100,000 per year, and it affects men more often than women.[1] The causes of SEH fall into 3 main categories: 1) Posttraumatic, following vertebral fractures, obstetrical birth trauma, epidural anesthesia, lumbar puncture, spinal surgery, and stab wounds; 2) a variety of predisposing conditions, such as anticoagulant therapy (recognized to be the most common predisposing factor), coagulation disorders, arteriovenous malformation, cavernous angiomas, spinal cord neoplasm, pregnancy, Paget's disease, hypertension, and collagen vascular disorder; and 3) spontaneous, for which no predisposing factors can be identified. According to Beatty and Winston,[2] bleeding from one of the epidural arteries is the most likely source of spontaneous SEH.

Typically, patients with SEH experience a sudden severe pain at the level of hemorrhage, which may radiate to the limbs.[3] The radicular pain may precede the spinal pain. A rapid development of neurological symptoms follows because of compression of the spinal cord or the cauda equina. Motor and sensory deficits develop, and patients may have urinary retention. The symptoms are usually progressive and may result in permanent neurological disability or even death due to respiratory failure if emergent neurosurgical intervention is delayed. These clinical features may resemble those of epidural neoplasia, transverse myelitis, dissecting aortic aneurysm, congenital cysts, spondylitis, epidural abscess, vertebral fractures, spinal cord infarction, and acutely ruptured disc.[4,5] In this case, the patient's history, the clinical and imaging findings, and the symptom evolution over time established the diagnosis of epidural hematoma.

From the imaging point of view, important pathologies in the epidural space of the spine that must be differentiated from SEH include spinal subdural hematomas, epidural metastases, epidural abscesses, epidural lipoma, and congenital cysts.

Spinal subdural hematomas are rare lesions that occur when extravasated blood accumulates in the preexisting subdural space. Typically, they extend over a long segment of the spinal canal, obliterating the subarachnoid space around the cord.


Epidural metastases are usually associated with bone destruction and are visible as homogeneous enhancement in postcontrast MR images.


Epidural abscesses are often associated with diskitis and/or osteomyelitis of the spine. The discs and the affected vertebrae show high signal intensity on T2W imaging and low signal intensity on T1W imaging. On postcontrast scans, homogeneous enhancement is observed in the epidural space during the initial stages of the inflammatory process caused by phlegmon on granulation tissue. Later, after liquefaction has taken place, fluid collections can be discerned within the enhancing abnormality of the epidural space. Abnormal increased enhancement is always observed in the affected disc or vertebrae.


Epidural lipoma is characterized by focal accumulation of fatty tissue with high signal on T1W and low signal on fat-suppression T2W techniques.[1,6]


Congenital cysts in the spinal canal are characterized by loculated fluid collections with signal intensities similar to that of cerebrospinal fluid on both T1W and T2W techniques. They present with mass effect but show no abnormal enhancement.


With the advent of MRI, epidural hematomas are now diagnosed more readily. The extent of these lesions in the spinal canal can be accurately assessed, and the degree of compromise of the spinal canal and spinal cord compression can easily be measured. Previously reported cases of spontaneous resolution of SEH[4,6-9] document the benign natural history of this complication, even when the hematoma extends over several vertebral segments. Thus, early enthusiasm for surgical management of SEH has gradually subsided, and a more conservative approach has been adopted. These reports have shown that the parameters that favor nonsurgical treatment include stable and nonprogressive neurological deficit of a mild degree and absent or only minimal cord compression.

http://www.medscape.com/viewarticle/523412_4
__________________
ADR Munich 26th July 2002 L5/S1. Aged 82 now
Your best asset is your health
My story is here
http://www.adrsupport.org/alastair.html
Thank goodness for Dr Zeegers I am painfree
I am here to help,I live in the UK


I now run the UK spine site and can be contacted at

www.adrsupportuk.com/
Reply With Quote
Reply

Bookmarks

Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off



All times are GMT -4. The time now is 06:30 AM.


© Copyright 2006-2023 ADRSupport.org All rights reserved.