Suzuki H, Yamamoto Y, Hoshino T, Yoneda C
Department of Neurosurgery, Matsusaka Chuo Sougo Hospital, Mie, Japan.
No Shinkei Geka. 1993 Dec;21(12):1119-23.
A 61-year-old man was referred to our department with spontaneously remitting sensorimotor disturbance and bowel and bladder dysfunctions. He had no specific previous history and neither received any drug nor suffered from hypertension. On onset, complete flaccid paralysis of lower extremities, almost complete sensory disturbance of all modalities below the level of Th12, and bowel and bladder dysfunctions were observed. MRI and CT scan revealed an epidural hematoma in the posterior region of the spinal cord at Th11 level. Afterwards he continued to improve gradually both clinically and radiologically. Four days subsequent to onset, on admission to our department, he had slight sensorimotor disturbance, and bowel and bladder dysfunctions still existed. MRI demonstrated a shrinking and flattened hematoma. We performed laminectomy and evacuation of the hematoma. Grossly and histologically, no underlying lesion was revealed. Postoperative course was not eventful. He was discharged without residual deficits. In our case, surgery accomplished three goals: definitive diagnosis, secure decompression and prevention of recurrence. We believe, the possibility of spontaneous resolution of spontaneous spinal epidural hematomas (SSEDHs) with spontaneous remission may be high, but prompt surgical evacuation should be the treatment of choice for such cases, even if no underlying lesion is revealed by MRI, except in cases where operative morbidity and mortality rate is high and in cases with no neurological deficits other than pain. A review of the literature indicated that not all SSEDHs with spontaneous remission resolved spontaneously and completely.
一名61岁男性因出现自发缓解的感觉运动障碍及大小便功能障碍被转诊至我科。他既往无特殊病史，未服用任何药物，也未患高血压。起病时，观察到双下肢完全弛缓性瘫痪，胸12水平以下几乎所有感觉模式完全丧失，以及大小便功能障碍。磁共振成像（MRI）和计算机断层扫描（CT）显示胸11水平脊髓后方硬膜外血肿。此后，他在临床和影像学上均逐渐好转。起病4天后，即入院时，他仍有轻微感觉运动障碍，大小便功能障碍依然存在。MRI显示血肿缩小且变平。我们进行了椎板切除术并清除血肿。大体及组织学检查均未发现潜在病变。术后病程顺利。他出院时无残留神经功能缺损。在我们的病例中，手术实现了三个目标：明确诊断、安全减压及预防复发。我们认为，自发缓解的自发性脊髓硬膜外血肿（SSEDHs）自行消退的可能性可能很高，但对于此类病例，即使MRI未发现潜在病变，除手术并发症和死亡率高的情况以及除疼痛外无神经功能缺损的情况外，及时手术清除血肿仍应作为首选治疗方法。文献综述表明，并非所有自发缓解的SSEDHs都能自发且完全消退。
