title: Spontaneous spinal epidural hematoma with spinal cord compression complicating plasma cell myeloma. A case report.
abstract: METHODS
  A case is reported in which a patient had acute paraplegia with sensory loss caused by a spontaneous epidural hematoma that was ascribed to bleeding of pre-existing myeloma lesions of the thoracic vertebrae.
  
  
  OBJECTIVE
  To highlight the causes of secondary epidural hematomas with special attention to pre-existing vertebral or epidural lesions.
  
  
  BACKGROUND
  There are no apparent previous reports of epidural spinal hematomas ascribed to underlying malignant diseases. Benign dysplasia, such as hemangioma or Paget's disease, has been implicated in a few cases.
  
  
  METHODS
  A case of spontaneous dorsal epidural hematoma is reported in a patient followed up for plasma cell myeloma with osteolytic lesions in the lower thoracic spine. There was no history of major trauma or coagulation disorders. Complete loss of motor and sensory function in both lower limbs was noted, with sphincter dysfunction. Magnetic resonance imaging of the thoracic spine showed a large posterolateral epidural hematoma responsible for spinal cord compression.
  
  
  RESULTS
  The patient failed to improve despite surgical decompression within 6 hours of symptom onset. He died 13 days later of refractory bacterial pneumonia. A large epidural hematoma adjacent to myelomatous lesions of the thoracic vertebrae was found at autopsy.
  
  
  CONCLUSIONS
  This is the first reported case of spontaneous epidural hematoma ascribed to underlying malignant disease, with confirmation of the diagnosis by postmortem examination. Possible mechanisms include tumor-related epidural inflammation and fragility of epidural venous plexuses.
authors.affiliation: Service de Rhumatologie, CHU Bichat-Claude Bernard, Paris, France. gilles.hayem@bch.ap-hop-paris.fr
authors.forename: G
authors.initials: G
authors.lastname: Hayem
authors.forename: E
authors.initials: E
authors.lastname: Deutsch
authors.forename: S
authors.initials: S
authors.lastname: Roux
authors.forename: E
authors.initials: E
authors.lastname: Palazzo
authors.forename: M
authors.initials: M
authors.lastname: Grossin
authors.forename: O
authors.initials: O
authors.lastname: Meyer
mesh_terms: D000368:Aged; D006407:Hematoma, Epidural, Cranial / Q000150:complications* / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009101:Multiple Myeloma / Q000150:complications* / Q000473:pathology; D010264:Paraplegia / Q000209:etiology; D013117:Spinal Cord Compression / Q000209:etiology* / Q000473:pathology; D013125:Spinal Neoplasms / Q000150:complications* / Q000473:pathology; D013904:Thoracic Vertebrae / Q000473:pathology