Neurosurgery Department, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
Neurorradiology Department, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal.
BMJ Case Rep. 2024 Apr 10;17(4):e259591. doi: 10.1136/bcr-2023-259591.
Spontaneous spine epidural haematoma is a rare occurrence, with an incidence of 0.1/100 000 inhabitants/year. The anterior location of the haematoma is very uncommon since the dural sac is firmly attached to the posterior longitudinal ligament. Vertebral artery dissection as its underlying cause is an exceptionally rare event, with only two documented cases.This article presents the case of young woman who arrived at the emergency room with a spinal ventral epidural haematoma extending from C2 to T10, caused by a non-traumatic dissecting aneurysm of the right vertebral artery at V2-V3 segment. Since the patient was tetraparetic, she underwent emergent laminectomy, and the vertebral artery dissection was subsequently treated endovascularly with stenting.Vertebral artery dissection with subsequent perivascular haemorrhage is a possible cause of spontaneous spine epidural haematoma, particularly when located ventrally in the cervical and/or high thoracic column. Hence the importance of a thorough investigation of the vertebral artery integrity.
自发性脊柱硬膜外血肿较为罕见，发病率为 0.1/100000 居民/年。血肿位于前方的情况非常少见，因为硬脊膜囊紧紧附着于后纵韧带。作为其潜在病因的椎动脉夹层是一种非常罕见的事件，仅有两例有文献记录。本文介绍了一例年轻女性的病例，她因右侧椎动脉 V2-V3 段非外伤性夹层动脉瘤导致 C2 至 T10 的脊柱腹侧硬膜外血肿而就诊于急诊。由于患者四肢瘫痪，因此进行了紧急椎板切除术，随后对椎动脉夹层进行了血管内支架置入治疗。椎动脉夹层伴随后的血管周围出血是自发性脊柱硬膜外血肿的可能原因，尤其是当血肿位于颈椎和/或胸上段的腹侧时。因此，彻底检查椎动脉完整性非常重要。
