Steinmetz Michael P, Kalfas Iain H, Willis Byron, Chalavi Ali, Harlan Richard C
Department of Neurosurgery, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Spine J. 2003 Nov-Dec;3(6):539-42.
A spontaneous epidural hematoma of the spine occurring during pregnancy is extremely rare. The development of a significant neurologic deficit may be rapid. Therefore, the neurosurgeon should be aware of the presentation, diagnosis and treatment options available.
The authors report a case of a spontaneous epidural hematoma of the spine during the third trimester of pregnancy, which was successfully managed with surgical evacuation. The case is unique in that the patient demonstrated a subacute presentation.
The authors report a case of a 27-year-old primagravada presented with the subacute onset of progressive paraparesis. She became nonambulatory before admission. A magnetic resonance imaging study (MRI) demonstrated ventral epidural compression in the upper thoracic region.
A retrospective review of a case of spontaneous epidural hematoma of the spine during pregnancy was performed. The inpatient and outpatient charts were used to gather clinical information of the case, and the pertinent radiographs and images were reviewed.
An urgent cesarean section was performed followed by evacuation of the epidural hematoma. The decompression was performed by means of a thoracic laminectomy with partial facetectomy. The patient had a prompt return of neurologic function.
Spontaneous epidural hematoma of the spine should be suspected in the setting of acute back or neck pain with or without an associated progressive neurologic deficit. Spine surgeons and obstetricians should also recognize that a spinal epidural hematoma during pregnancy may also present subacutely, as illustrated in our case. Prompt diagnosis may be made with MRI, and evacuation of the hematoma should be performed, ideally before the onset of neurologic signs or symptoms. The prognosis for return of neurologic function is good after urgent evacuation.
孕期发生的自发性脊柱硬膜外血肿极为罕见。严重神经功能缺损可能迅速发展。因此，神经外科医生应了解其临床表现、诊断及可用的治疗方案。
作者报告一例妊娠晚期发生的自发性脊柱硬膜外血肿病例，通过手术清除血肿成功治疗。该病例的独特之处在于患者表现为亚急性症状。
作者报告一例27岁初产妇，出现亚急性进行性双下肢轻瘫。入院前已无法行走。磁共振成像（MRI）检查显示上胸段腹侧硬膜外受压。
对一例孕期自发性脊柱硬膜外血肿病例进行回顾性研究。利用住院和门诊病历收集该病例的临床信息，并复查相关的X线片和影像资料。
紧急行剖宫产术，随后清除硬膜外血肿。通过胸椎椎板切除术加部分关节突切除术进行减压。患者神经功能迅速恢复。
在出现急性背痛或颈痛且伴有或不伴有相关进行性神经功能缺损的情况下，应怀疑存在自发性脊柱硬膜外血肿。脊柱外科医生和产科医生还应认识到，孕期脊柱硬膜外血肿也可能呈亚急性表现，如我们的病例所示。MRI可做出快速诊断，应进行血肿清除，理想情况是在神经体征或症状出现之前进行。紧急清除血肿后神经功能恢复的预后良好。
