title: Spontaneous spinal epidural hematoma after abrupt sneezing with prompt recovery of severe paraparesis.
abstract: Spontaneous spinal epidural hematoma (SSEH) is a rare neurologic condition with threatening consequences when spinal cord compression is present. The diagnosis must be performed quickly using magnetic resonance imaging (MRI), which shows collection of blood in the epidural space. With spinal cord compression, there is an indication for urgent surgical decompression. Here, we present a 64-year-old woman who developed sudden thoracic and lower back pain accompanied by severe paraparesis and urinary retention after sneezing abruptly. An MRI revealed a posterior thoracic epidural hematoma extending from the T6 to T11 vertebral level with spinal cord compression. Decompression was recommended, but the patient refused surgery, while neurologically improving with time. Complete neurologic recovery was observed within 24 hours after SSEH onset. A conservative therapeutic approach with careful observation may therefore be considered as a treatment of choice in some cases where surgery is refused, (due to high risk or other reasons) and neurologic recovery is early and sustained.
authors.affiliation: Department of Neurology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic. Electronic address: ivana.stetkarova@fnkv.cz.
authors.forename: Ivana
authors.initials: I
authors.lastname: Štětkářová
authors.affiliation: Department of Neurology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic.
authors.forename: Lenka
authors.initials: L
authors.lastname: Jelínková
authors.affiliation: Department of Radiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic.
authors.forename: Vaclav
authors.initials: V
authors.lastname: Janík
authors.affiliation: Department of Neurology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic.
authors.forename: Tomas
authors.initials: T
authors.lastname: Peisker
mesh_terms: D005260:Female; D046748:Hematoma, Epidural, Spinal / Q000150:complications / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D020335:Paraparesis / Q000209:etiology*; D012075:Remission, Spontaneous; D012912:Sneezing / Q000502:physiology