title: An unusually rapid spontaneous recovery in a patient with spinal epidural hematoma.
abstract: BACKGROUND
  Spontaneous epidural hematoma is a rare condition, which usually requires urgent surgical treatment.
  
  
  OBJECTIVE
  To report two cases of spontaneous epidural hematoma, one of which was treated conservatively, and the other surgically, and discuss the possibility of unusual spontaneous recovery and treatment decision-making.
  
  
  METHODS
  We encountered 2 patients with spontaneous spinal epidural hematoma, both of whom were taking an anti-platelet agent, producing severe paraplegia. One patient with a hematoma at C2-T3 experienced a rapid neurological recovery while a magnetic resonance imaging scan was being performed. A complete resolution of the hematoma and complete neurological recovery ensued without surgical intervention. A second patient with a hematoma at T10-12 showed no neurological recovery up to the time emergency surgery started and was treated surgically by T10-12 laminectomy and excision of the hematoma. Neurological function returned to normal in both patients.
  
  
  CONCLUSIONS
  The occurrence of spontaneous recovery in some patients makes the decision for surgery difficult. Emergency physicians need to be aware of the possibility of spontaneous rapid neurological recovery in patients with spinal epidural hematoma. To avoid unnecessary surgery in patients who will spontaneously have neurological recovery, neurological evaluations need to be repeatedly performed up to the time the emergency surgery begins. However, unfortunately, there is no diagnostic tool at present to identify the patients who recover spontaneously, and the interval between onset and surgery is correlated with clinical results, therefore, conservative treatment should be prescribed only for those patients who exhibit improving neurological signs early in the clinical course.
authors.affiliation: Department of Orthopedic Surgery, Chiba Rosai Hospital, Ichihara, Chiba, Japan.
authors.forename: Yasuchika
authors.initials: Y
authors.lastname: Aoki
authors.forename: Masatsune
authors.initials: M
authors.lastname: Yamagata
authors.forename: Koh
authors.initials: K
authors.lastname: Shimizu
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Ikeda
authors.forename: Fumitake
authors.initials: F
authors.lastname: Nakajima
authors.forename: Seiji
authors.initials: S
authors.lastname: Ohtori
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Takahashi
mesh_terms: D000369:Aged, 80 and over; D002574:Cervical Vertebrae; D005260:Female; D046748:Hematoma, Epidural, Spinal / Q000150:complications / Q000601:surgery*; D006801:Humans; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000209:etiology; D012075:Remission, Spontaneous; D013904:Thoracic Vertebrae