Effective Steroid Treatment in Traumatic Cervical Spinal Epidural Hematoma Presenting with Delayed Tetraparesis: Two Case Reports and Literature Review.
BACKGROUND
Traumatic spinal epidural hematoma (TSEH) is a rare neurosurgical condition that according to conventional treatment requires prompt surgical decompression. Recent reports, however, suggest that conservative management within the acute phase after trauma also can lead to similar long-term functional outcomes without the need for immediate neurosurgical intervention.


METHODS
In the present paper, we describe 2 cases of TSEH located in the ventral upper cervical spine, which presented with delayed neurologic deficits. In both cases, conservative management with steroid treatment was initiated before neurosurgical decompression, resulting in improved neurologic outcomes.


CONCLUSIONS
Urgent surgical decompression may not be necessary acutely in patients with TSEH who respond well to conservative therapy. Although there is currently no consensus for the initial management strategies, steroid treatment could individually tailored and applied according to the clinical condition and evolving symptoms.
Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung Medical College and University, Taoyuan, Taiwan.
Tzu-Chin
TC
Lin
Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung Medical College and University, Taoyuan, Taiwan.
Zhuo-Hao
ZH
Liu
Royal Free London NHS Foundation Trust, London, United Kingdom.
Amy L
AL
Bowes
Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung Medical College and University, Taoyuan, Taiwan.
Shih-Tseng
ST
Lee
Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung Medical College and University, Taoyuan, Taiwan. Electronic address: albert3343@gmail.com.
Po-Hsun
PH
Tu
D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D019299:Decompression, Surgical / Q000379:methods*; D023261:Glasgow Outcome Scale; D046748:Hematoma, Epidural, Spinal / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D006429:Hemiplegia / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D013256:Steroids / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed
D013256:Steroids
Spinal epidural hematoma; Steroid; Ventral cervical spine; trauma