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* This is the Professional Version. *

Spinal Subdural or Epidural Hematoma

By Michael Rubin, MDCM, Weill Cornell Medical College;New York Presbyterian Hospital-Cornell Medical Center

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Patient Education

A spinal subdural or epidural hematoma is an accumulation of blood in the subdural or epidural space that can mechanically compress the spinal cord. Diagnosis is by MRI or, if not immediately available, by CT myelography. Treatment is with immediate surgical drainage.

Spinal subdural or epidural hematoma (usually thoracic or lumbar) is rare but may result from back trauma, anticoagulant or thrombolytic therapy, or, in patients with bleeding diatheses, lumbar puncture.

Symptoms and Signs

Symptoms of a spinal subdural or epidural hematoma begin with local or radicular back pain and percussion tenderness; they are often severe. Spinal cord compression may develop; compression of lumbar spinal roots may cause cauda equina syndrome and lower extremity paresis. Deficits progress over minutes to hours.

Diagnosis

  • MRI

Hematoma is suspected in patients with acute, nontraumatic spinal cord compression or sudden, unexplained lower extremity paresis, particularly if a possible cause (eg, trauma, bleeding diathesis) is present.

Diagnosis is by MRI or, if MRI is not immediately available, by CT myelography.

Treatment

  • Drainage

Treatment of a spinal subdural or epidural hematoma is immediate surgical drainage.

Patients taking coumarin anticoagulants are given phytonadione (vitamin K1) 2.5 to 10 mg sc and fresh frozen plasma as needed to normalize INR. Patients with thrombocytopenia are given platelets.

* This is the Professional Version. *