Sach Gabrielle, Crouch Catherine, Seeho Sean
Department of Obstetrics & Gynaecology, Royal North Shore Hospital, Northern Sydney Local Health District, Reserve Rd, St Leonards, NSW 2065, Australia.
Faculty of Medicine and Health Sciences, Macquarie University, Technology Place, Macquarie Park, NSW 2113, Australia.
Case Rep Womens Health. 2025 Aug 5;47:e00740. doi: 10.1016/j.crwh.2025.e00740. eCollection 2025 Oct.
Spontaneous epidural haematomas are rare, and few cases have been reported in pregnancy. Frequently with back pain, and rapidly progressing neurological changes where spinal cord compression is present, magnetic resonance imaging (MRI) is the gold standard for diagnosis. Management generally involves prompt surgical decompression of the spinal cord. Limited access to specialist care and imaging in rural areas is a barrier to timely diagnosis and treatment. This case report outlines the diagnosis and management of a woman in her mid-twenties, presenting at 38 weeks of gestation to a rural hospital with back pain and lower limb weakness. MRI revealed spinal cord compression from an epidural cystic mass, suspected to be a haematoma. She was airlifted to a tertiary centre for an emergency caesarean section and subsequent laminectomy. Histopathology suggested an underlying arteriovenous malformation as the most likely cause. This case highlights the diagnostic and management challenges of spontaneous epidural hematomas in pregnancy, particularly in resource-limited rural environments.
自发性硬膜外血肿较为罕见，孕期病例报道较少。常伴有背痛，出现脊髓受压时神经功能变化迅速，磁共振成像（MRI）是诊断的金标准。治疗通常需要迅速对脊髓进行手术减压。农村地区获得专科护理和影像检查的机会有限，这是及时诊断和治疗的障碍。本病例报告概述了一名二十多岁女性的诊断和治疗情况，该女性在妊娠38周时因背痛和下肢无力就诊于一家农村医院。MRI显示硬膜外囊性肿块压迫脊髓，怀疑为血肿。她被空运至三级医疗中心进行紧急剖宫产及随后的椎板切除术。组织病理学提示潜在的动静脉畸形是最可能的病因。本病例突出了孕期自发性硬膜外血肿的诊断和治疗挑战，尤其是在资源有限的农村环境中。
