title: Spontaneous spinal epidural hematoma: the importance of preoperative neurological status and rapid intervention.
abstract: We describe the presentation, management, and outcome of spontaneous spinal epidural hematoma (SSEH) in two tertiary academic centers. We retrospectively reviewed clinical and imaging files in patients diagnosed with SSEH from 2002-2011. Neurologic status was assessed using the American Spinal Injury Association (ASIA) Impairment Scale (AIS). A total of 17 patients (10 females; mean age 54 years, range 10-89) were included. Among patients presenting with AIS A, 5/8 showed no improvement and 3/8 reached AIS C. Among those presenting with AIS C, 5/6 reached AIS E and 1/6 reached AIS D. Of those presenting with AIS D, 3/3 reached AIS E. Mean time-to-surgery (TTS) was 28 hours (range 3-96). TTS surgery in two patients remaining at AIS A was ⩽ 12 hours; in 4/8 patients recovering to AIS E it was > 12 hours, including three patients operated on after > 24 hours. In patients remaining at AIS A, a mean of 4.4 levels were treated compared with means of 3.7 and 3.5 in those with AIS C and E, respectively, at late follow-up. In this series, preoperative neurological status had greater impact on late outcome than time from symptom onset to surgery in patients with SSEH.
authors.affiliation: Department of Neurosurgery, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Rajz
authors.affiliation: Department of Neurosurgery, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel.
authors.forename: José E
authors.initials: JE
authors.lastname: Cohen
authors.affiliation: Department of Neurosurgery, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Sagi
authors.initials: S
authors.lastname: Harnof
authors.affiliation: Department of Neurosurgery, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Nachshon
authors.initials: N
authors.lastname: Knoller
authors.affiliation: Department of Neurosurgery, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Oded
authors.initials: O
authors.lastname: Goren
authors.affiliation: Department of Neurosurgery, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel.
authors.forename: Yigal
authors.initials: Y
authors.lastname: Shoshan
authors.affiliation: Department of Neurosurgery, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel.
authors.forename: Shifra
authors.initials: S
authors.lastname: Fraifeld
authors.affiliation: Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Leon
authors.initials: L
authors.lastname: Kaplan
authors.affiliation: Department of Neurosurgery, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel. Electronic address: eyal.itshayek@gmail.com.
authors.forename: Eyal
authors.initials: E
authors.lastname: Itshayek
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D002648:Child; D003937:Diagnosis, Differential; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D046748:Hematoma, Epidural, Spinal / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D019635:Neurosurgical Procedures; D010808:Physical Examination; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000925:Anticoagulants
keywords: Acute paraplegia; Decompressive laminectomy; Epidural hematoma; Spontaneous spinal epidural hematoma