Successful surgical management of a case of spontaneous epidural hematoma of the spine during pregnancy.
BACKGROUND
A spontaneous epidural hematoma of the spine occurring during pregnancy is extremely rare. The development of a significant neurologic deficit may be rapid. Therefore, the neurosurgeon should be aware of the presentation, diagnosis and treatment options available.


OBJECTIVE
The authors report a case of a spontaneous epidural hematoma of the spine during the third trimester of pregnancy, which was successfully managed with surgical evacuation. The case is unique in that the patient demonstrated a subacute presentation.


METHODS
The authors report a case of a 27-year-old primagravada presented with the subacute onset of progressive paraparesis. She became nonambulatory before admission. A magnetic resonance imaging study (MRI) demonstrated ventral epidural compression in the upper thoracic region.


METHODS
A retrospective review of a case of spontaneous epidural hematoma of the spine during pregnancy was performed. The inpatient and outpatient charts were used to gather clinical information of the case, and the pertinent radiographs and images were reviewed.


RESULTS
An urgent cesarean section was performed followed by evacuation of the epidural hematoma. The decompression was performed by means of a thoracic laminectomy with partial facetectomy. The patient had a prompt return of neurologic function.


CONCLUSIONS
Spontaneous epidural hematoma of the spine should be suspected in the setting of acute back or neck pain with or without an associated progressive neurologic deficit. Spine surgeons and obstetricians should also recognize that a spinal epidural hematoma during pregnancy may also present subacutely, as illustrated in our case. Prompt diagnosis may be made with MRI, and evacuation of the hematoma should be performed, ideally before the onset of neurologic signs or symptoms. The prognosis for return of neurologic function is good after urgent evacuation.
Steinmetz
Michael P
MP
Department of Neurosurgery, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Kalfas
Iain H
IH
Willis
Byron
B
Chalavi
Ali
A
Harlan
Richard C
RC
Chahlavi
Ali
A
D000328:Adult; D004824:Epidural Space; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007796:Laminectomy / Q000379:methods; D008279:Magnetic Resonance Imaging; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000601:surgery*; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third; D035583:Rare Diseases; D018570:Risk Assessment; D013118:Spinal Cord Diseases / Q000175:diagnosis / Q000601:surgery*; D013904:Thoracic Vertebrae; D016896:Treatment Outcome