Zhang B, Chen J, Zou N, Wang L, Wang H, Jiang J, Chen D, Lu X
Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, No. 415, Feng Yang Street, Huangpu District, Shanghai 200003, China.
Department of Neurosurgery, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
Neurochirurgie. 2019 Feb;65(1):27-31. doi: 10.1016/j.neuchi.2018.10.008. Epub 2019 Jan 8.
To present the natural course and treatment modalities of spontaneous cervical epidural hematoma (SCEH), by reporting two rare cases with spontaneous resolution in both clinical and radiologic findings without surgery.
One patient presenting with acute right side hemiparesis and another showing pure cervical radiculopathy were diagnosed with SCEH on magnetic resonance imaging (MRI). Both were both treated non-operatively. We also conducted a literature review of 19 cases of spontaneous spinal epidural hematoma (SSEH).
These two patients achieved complete resolution in terms of both neurologic function and radiologic findings within 21 days after onset. In the literature review, 63.2% of cases experienced neurologic improvement in the first 24h, 78.9% achieved complete neurologic recovery within 1 month, and radiological images showed complete resolution of hematoma in the first month for 73.7% of patients.
Atypical cervical SSEH can mimic cerebral stroke or a ruptured cervical disc. A high index of clinical suspicion followed by MRI examination is critical for diagnosis. Prompt surgical decompression and evacuation of the hematoma is generally regarded as first-line treatment. However, for patients without or with only slight neurologic symptoms, or showing early and sustained neurologic improvement, non-surgical therapy with close observation is a viable alternative. Both neurologic and radiologic resolution can be expected within the first month following onset in most cases of spontaneous resolution of SSEH.
通过报告两例罕见的临床和影像学表现均自发缓解且未行手术治疗的病例，介绍自发性颈段硬膜外血肿（SCEH）的自然病程和治疗方式。
一名表现为急性右侧偏瘫的患者和另一名表现为单纯颈神经根病的患者经磁共振成像（MRI）诊断为SCEH。两者均接受了非手术治疗。我们还对19例自发性脊柱硬膜外血肿（SSEH）病例进行了文献回顾。
这两名患者在发病后21天内神经功能和影像学表现均完全恢复。在文献回顾中，63.2%的病例在最初24小时内神经功能有改善，78.9%在1个月内实现神经功能完全恢复，73.7%的患者在第一个月内血肿在影像学上完全吸收。
非典型颈段SSEH可模仿脑卒中或颈椎间盘破裂。高度的临床怀疑并随后进行MRI检查对诊断至关重要。迅速的手术减压和血肿清除通常被视为一线治疗方法。然而，对于无神经症状或仅有轻微神经症状，或表现出早期且持续神经功能改善的患者，密切观察下的非手术治疗是一种可行的选择。在大多数SSEH自发缓解的病例中，发病后第一个月内可预期神经功能和影像学均恢复正常。
