Kherchttou Yassine, Ait Riala Montacer, Ouachaou Jamal, Mourouth Hanane, Youssef Zarrouki
Anesthesia and Intensive Care Unit, Mohammed VI University Hospital, Marrakech, MAR.
Cureus. 2025 Apr 27;17(4):e83086. doi: 10.7759/cureus.83086. eCollection 2025 Apr.
Spontaneous spinal hematomas are rare but potentially life-threatening, particularly during pregnancy, where they can mimic other spinal lesions, complicating diagnosis and management. We report a case of a 26-year-old pregnant woman at 23 weeks of gestation, who presented with sudden-onset paraparesis. Neurological examination revealed signs of spinal cord compression, and MRI suggested a spinal meningioma due to an extramedullary tissue process at the D3-D4 level. Despite a normal coagulation profile, emergency laminectomy (D2-D6) was performed, revealing and evacuating a spontaneous spinal hematoma. No active bleeding source or vascular malformation was identified, and fetal assessments remained stable. The pathophysiology of spontaneous spinal hematomas in pregnancy is multifactorial, involving increased vascular fragility due to pregnancy-induced hemodynamic and hormonal changes, including elevated estrogen and progesterone levels and a hypercoagulable state. Additionally, increased intra-abdominal pressure from the gravid uterus may contribute by exacerbating spinal venous congestion. Distinguishing spinal hematomas from meningiomas is challenging due to overlapping clinical and imaging features; however, the sudden onset of symptoms and characteristic MRI signal patterns can aid in differentiation. This case underscores the importance of considering spontaneous spinal hematoma in pregnant patients with acute neurological symptoms. Early recognition and timely surgical decompression are essential to prevent irreversible neurological deficits and optimize maternal and fetal outcomes. Further research is needed to better understand the underlying mechanisms and improve management strategies for this rare but serious condition.
自发性脊髓血肿罕见但可能危及生命，在孕期尤其如此，因为它们可类似其他脊髓病变，使诊断和治疗复杂化。我们报告一例26岁孕23周的孕妇，她出现突发双下肢轻瘫。神经系统检查显示脊髓受压体征，磁共振成像（MRI）提示因D3 - D4水平髓外组织病变而患有脊髓膜瘤。尽管凝血指标正常，仍进行了急诊椎板切除术（D2 - D6），发现并清除了自发性脊髓血肿。未发现活动性出血源或血管畸形，胎儿评估保持稳定。孕期自发性脊髓血肿的病理生理学是多因素的，涉及妊娠引起的血流动力学和激素变化导致的血管脆性增加，包括雌激素和孕激素水平升高以及高凝状态。此外，妊娠子宫引起的腹内压增加可能通过加剧脊髓静脉充血而起到作用。由于临床和影像学特征重叠，区分脊髓血肿和脊髓膜瘤具有挑战性；然而，症状的突然发作和特征性MRI信号模式有助于鉴别。该病例强调了在有急性神经症状的孕妇中考虑自发性脊髓血肿的重要性。早期识别和及时手术减压对于预防不可逆神经功能缺损以及优化母婴结局至关重要。需要进一步研究以更好地理解潜在机制并改善对这种罕见但严重病症的管理策略。
