Ogawa Katsuhiko, Akimoto Takayoshi, Hara Makoto, Fujishiro Midori, Uei Hiroshi, Nakajima Hideto
Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan.
Department of Neurology, Akabane Central General Hospital, Tokyo 115-0044, Japan.
Neurol Int. 2023 Mar 7;15(1):362-370. doi: 10.3390/neurolint15010024.
(1) Introduction: Spontaneous spinal epidural hematoma (SSEH) points to hematoma within the epidural space of the spinal cord without traumatic or iatrogenic causes. (2) Case Reports: One patient showed paraplegia, numbness of both legs with acute onset, acute myelopathic signs, subsequent to back pain. Magnetic resonance imaging (MRI) showed hematoma in the posterior part of the thoracic spinal cord. Another patient showed acute numbness in the shoulder, upper part of the back, and the upper extremity on the right side after pain in the back, shoulder, and neck on the right side. Sagittal computed tomography (CT) images of the cervical bone showed a high-density area behind the spinal cord between C4 and C7. MRI analysis showed hematoma in the right diagonally posterior part of the cervical spinal cord. These 2 patients lacked traumatic or iatrogenic events, and their symptoms abated without surgical operation. (3) Conclusions: The location of hematoma correlated with symptoms in each patient. SSEH is rare but should be taken into account in patients with myelopathy or radiculopathy with acute onset subsequent to back pain. The usefulness of emergent CT scans of the spinal cord prior to MRI analysis was shown in the diagnosis of SSEH.
(1) 引言：自发性脊髓硬膜外血肿（SSEH）是指脊髓硬膜外间隙内出现的血肿，且无创伤性或医源性病因。(2) 病例报告：一名患者在背痛后出现急性截瘫、双腿麻木及急性脊髓病体征。磁共振成像（MRI）显示胸段脊髓后部有血肿。另一名患者在右侧背部、肩部和颈部疼痛后，出现右侧肩部、背部上部及上肢急性麻木。颈椎矢状位计算机断层扫描（CT）图像显示脊髓后方C4至C7之间有高密度区。MRI分析显示颈段脊髓右斜后方有血肿。这两名患者均无创伤性或医源性事件，且症状未经手术即缓解。(3) 结论：血肿位置与每位患者的症状相关。SSEH罕见，但对于背痛后急性起病的脊髓病或神经根病患者应予以考虑。在SSEH的诊断中，显示了在MRI分析之前进行脊髓紧急CT扫描的有用性。
