title: Spontaneous spinal epidural hematoma during pregnancy.
abstract: BACKGROUND
  Spontaneous spinal epidural hematoma is a rare phenomenon that has no distinct etiology. Spontaneous spinal epidural hematoma (SSEH) during pregnancy is extremely rare. We present what we believe to be the fifth reported case of spontaneous spinal epidural hematoma associated with pregnancy in the English literature.
  
  
  METHODS
  A 31-year-old female presented with acute onset of paraplegia at 32 weeks of pregnancy. The patient had a T2 sensory level and complete paralysis of all lower extremity motor groups. Magnetic resonance imaging of the thoracic spine showed an acute epidural hematoma posterior to the thoracic spinal cord between the second and fourth thoracic vertebrae.
  
  
  RESULTS
  The patient was taken to the operating room were her child was delivered by caesarean section. She then underwent a posterior laminectomy and evacuation of a spinal epidural hematoma. Follow-up selective spinal angiography was negative for any vascular malformation. The patient gradually recovered lower extremity function and was independently ambulating at six month follow-up. Voluntary bowel and bladder function returned within four months but twice daily intermittent catheterization remained necessary for excessive post-void residual urine.
  
  
  CONCLUSIONS
  Spontaneous spinal epidural hematoma in pregnancy is a rare phenomenon. It is postulated that elevated venous pressure associated with pregnancy may be a contributing factor. In the reported cases of SSEH in pregnancy most patients presented with acute symptoms, thoracic location and profound neurological deficits but, with prompt surgical treatment, generally had good long term recovery.
authors.affiliation: Division of Neurology, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada.
authors.forename: Michael E B
authors.initials: ME
authors.lastname: Kelly
authors.forename: R Cole
authors.initials: RC
authors.lastname: Beavis
authors.forename: Suzanne
authors.initials: S
authors.lastname: Hattingh
mesh_terms: D000328:Adult; D005260:Female; D046748:Hematoma, Epidural, Spinal / Q000150:complications / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D019635:Neurosurgical Procedures; D010243:Paralysis / Q000209:etiology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000473:pathology*; D014546:Urinary Catheterization