Spontaneous spinal epidural haematoma: a retrospective study of a series of 13 cases.
BACKGROUND
Spontaneous spinal epidural haematoma (SSEH) has an estimated incidence of one per million inhabitants. It is classified as spontaneous when no identifiable cause can be linked to its onset.


OBJECTIVE
To describe a sample of patients with SSEH and analyse variables related to its functional prognosis.


METHODS
Retrospective study carried out in patients diagnosed with SSEH between 2001 and 2013 in our hospital.


RESULTS
We included 13 subjects (7 men) with a mean age of 71 years. Of the total, 62% had hypertension and 54% were treated with oral anticoagulants; of the latter, 57% had an International Normalised Ratio above 3. The most frequent manifestation was spinal column pain (85%). Nearly all subjects presented an associated neurological deficit, whether sensory-motor (70%), pure motor (15%), or pure sensory (7%). Five patients underwent surgical treatment and 8 had conservative treatment. After one year, 3 of the patients treated surgically and 4 of those on conservative treatment had a score of 2 or lower on the modified Rankin Scale. Poorer prognosis was observed in patients with anticoagulant therapy, large haematomas, location in the lumbar region, and more pronounced motor disability at onset.


CONCLUSIONS
Old age, hypertension, and anticoagulant therapy are the main risk factors for SSEH. The typical presentation consists of back pain with subsequent motor deficit. In patients with established motor symptoms, surgical treatment within the first 24hours seems to be the best option.
Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España. Electronic address: adrianamunozneurologia@gmail.com.
A
A
Muñoz González
Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
J P
JP
Cuello
Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
P M
PM
Rodríguez Cruz
Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
A M
AM
Iglesias Mohedano
Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
R
R
Domínguez Rubio
Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
F
F
Romero Delgado
Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
A
A
García Pastor
Servicio de Radiología, Hospital General Universitario Gregorio Marañón, Madrid, España.
J
J
Guzmán de Villoria Lebiedziejswki
Servicio de Radiología, Hospital General Universitario Gregorio Marañón, Madrid, España.
P
P
Fernández García
Servicio de Radiología, Hospital General Universitario Gregorio Marañón, Madrid, España.
J
J
Romero Martínez
Servicio de Neurología, Hospital Universitario Quirón Madrid, Madrid, España.
D
D
Ezpeleta Echevarri
Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
F
F
Díaz Otero
Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
P
P
Vázquez Alen
Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
J A
JA
Villanueva Osorio
Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
A
A
Gil Núñez
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D046748:Hematoma, Epidural, Spinal / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D006973:Hypertension / Q000150:complications; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
D000925:Anticoagulants
Compresión medular; Enfermedades médula espinal; Epidural haematoma; Hematoma epidural; Hematoma espinal; Laminectomy; Laminectomía; Mielopatía; Myelopathy; Spinal cord compression; Spinal cord diseases; Spinal haematoma