Spontaneous resolution of a traumatic cervicothoracic epidural hematoma presenting with transient paraplegia: a case report.
METHODS
Case description.


OBJECTIVE
To clinically and radiographically describe a traumatic spinal epidural hematoma (TSEH) without adjacent spinal column fracture or soft tissue injury that completely resolved, without surgical intervention.


BACKGROUND
Symptomatic TSEH is an infrequent condition after spinal trauma, accounting for 0.5% to 1.7% of cases. It can result in permanent neurologic deficits if not treated in a timely and appropriate manner.


METHODS
A 50-year-old man presented with progressive lower motor weakness and sensory change at 2 days after blunt trauma to the upper back area. Neurologic examination revealed paraplegia and hypesthesia below the T4 sensory dermatome. Magnetic resonance imaging for cervicothoracic spine showed a space-occupying lesion in the dorsal spinal epidural space from C7 to T5. The lesion was consistent with acute stage hematoma of the spinal epidural space.


RESULTS
The patient was prepared for decompression surgery. However, the patient's neurologic symptoms began to improve (grade 4/5) at 2 hours after onset of paraplegia. Surgical intervention was delayed, and the patient was treated conservatively with close neurologic monitoring. Three days after onset of symptoms, the patient's neurologic symptoms recovered completely. The follow-up magnetic resonance imaging at 12 days after the event showed complete resolution of the epidural hematoma.


CONCLUSIONS
An unpredictable extensive epidural hematoma can occur after blunt trauma of the cervicothoracic spine in patients at low risk for hemorrhage. This case illustrates that immediate surgical intervention may not always be necessary in certain patients with TSEH. Conservative management with careful observation may play a role as a management option for patients initially presenting with severe neurologic dysfunction if neurologic recovery is early and sustained.
Jang
Jae-Won
JW
Department of Neurosurgery, Chonnam National University Medical School and Research Institute of Medical Sciences, Gwangju, Republic of Korea.
Lee
Jung-Kil
JK
Seo
Bo-Ra
BR
Kim
Jae-Hyoo
JH
Kim
Soo-Han
SH
D002574:Cervical Vertebrae / Q000293:injuries*; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D046748:Hematoma, Epidural, Spinal / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000175:diagnosis* / Q000209:etiology; D012075:Remission, Spontaneous; D013904:Thoracic Vertebrae / Q000293:injuries*; D013997:Time Factors; D014947:Wounds and Injuries / Q000150:complications / Q000175:diagnosis