Recognizing spontaneous spinal epidural hematoma.

Sudden, often severe pain in the spinal region that is followed-sometimes within minutes-by paraplegia may signal spontaneous spinal epidural hematoma. This is a true surgical emergency calling for immediate laminectomy. Otherwise, the neurologic deficit becomes irreversible and the patient probably will die. The cause may be a fall or straining but in most cases there's no history of trauma. A myelogram reveals a block at the level of the hematoma, usually in the thoracic region or in the cervicothoracic or thoracolumbar area. Manometric tests shouldn't be done because they can increase the neurologic deficit. Urinary retention and sensitivity to pinprick at the level of the hematoma are additional diagnostic clues. The case reported here and 13 others from the literature point up the importance of prompt surgical treatment. Eight of the 12 patients who had laminectomy improved and five of them recovered completly, but both of the patients who were not treated surgically died.