Wells Chin Y, Heigle Benjamin, Pannu Prabhneet, Pham Stephen, Ghneim Ziad, Dadi Neelakanta
Internal Medicine, Unity Health-White County Medical Center, Searcy, USA.
Hematology/Oncology, Unity Health-White County Medical Center, Searcy, USA.
Cureus. 2024 Sep 8;16(9):e68939. doi: 10.7759/cureus.68939. eCollection 2024 Sep.
Spinal epidural hematomas (SEH) are rare, and cases with a spontaneous etiology are even more infrequent. Management of spontaneous SEH varies, with surgical or conservative approaches determined by the severity of deficits and symptom resolution. Adverse prognostic factors may include thoracic segment location, anticoagulation use, severe neurologic deficits at admission, sphincter dysfunction, and rapid progression. We report a patient with a sudden onset of bilateral lower limb weakness and reduced urinary output. Magnetic resonance imaging was conducted and indicated an epidural hematoma extending from T11 to L4. Surgical decompression and hematoma extraction were performed successfully resulting in the complete resolution of symptoms. This case underscores the importance of considering spontaneous SEH in patients lacking conventional risk factors, such as a history of trauma, when presenting with symptoms of bilateral lower limb weakness and decreased urine output. Depending on the severity of symptoms and the occurrence of spontaneous and rapid improvement, the patient may benefit from surgical intervention, which ameliorated the patient's symptoms in this case.
脊髓硬膜外血肿（SEH）较为罕见，病因自发的病例更是少见。自发性SEH的治疗方法各异，手术或保守治疗方法取决于神经功能缺损的严重程度和症状缓解情况。不良预后因素可能包括胸段位置、抗凝药物的使用、入院时严重的神经功能缺损、括约肌功能障碍以及病情快速进展。我们报告一例患者，突发双侧下肢无力且尿量减少。进行了磁共振成像检查，结果显示硬膜外血肿从T11延伸至L4。成功实施了手术减压和血肿清除，症状完全缓解。该病例强调了在缺乏创伤史等传统危险因素的患者出现双侧下肢无力和尿量减少症状时，考虑自发性SEH的重要性。根据症状的严重程度以及症状自发快速改善的情况，患者可能从手术干预中获益，本病例中手术改善了患者的症状。
