(See also Overview of Spinal Cord Disorders Overview of Spinal Cord Disorders Spinal cord disorders can cause permanent severe neurologic disability. For some patients, such disability can be avoided or minimized if evaluation and treatment are rapid. The spinal cord... read more .)
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 of Spinal Subdural or Epidural Hematoma
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 Spinal Cord Compression Various lesions can compress the spinal cord, causing segmental sensory, motor, reflex, and sphincter deficits. Diagnosis is by MRI. Treatment is directed at relieving compression. (See also... read more may develop; compression of lumbar spinal roots may cause cauda equina syndrome Cauda equina injury Trauma to the spine may cause injuries involving the spinal cord, vertebrae, or both. Occasionally, the spinal nerves are affected. The anatomy of the spinal column is reviewed elsewhere. Spinal... read more and lower-extremity paresis. Deficits progress over minutes to hours.
Diagnosis of Spinal Subdural or Epidural Hematoma
Hematoma is suspected in patients with symptoms and signs of acute, nontraumatic spinal cord compression or sudden, unexplained lower extremity paresis, particularly if a possible cause (eg, trauma, bleeding diathesis) is present.
Diagnosis of a spinal subdural or epidural hematoma is by MRI or, if MRI is not immediately available, by CT myelography.
Treatment of Spinal Subdural or Epidural Hematoma
Treatment of a spinal subdural or epidural hematoma is immediate surgical drainage.
Patients taking warfarin or other vitamin K antagonist anticoagulants are given phytonadione (vitamin K1) 2.5 to 10 mg and fresh frozen plasma as needed to normalize the INR (international normalized ratio). phytonadione is given IV if urgent treatment is needed; it is given orally if treatment is not urgently needed. Patients with thrombocytopenia are given platelets Platelets Whole blood can provide improved oxygen-carrying capacity, volume expansion, and replacement of clotting factors and was previously recommended for rapid massive blood loss. However, because... read more .
Suspect spinal subdural or epidural hematoma in patients with local or radicular back pain and percussion tenderness or sudden, unexplained lower-extremity paresis, particularly if a possible cause (eg, trauma, bleeding diathesis) is present.
Diagnose using MRI or, if MRI is not immediately available, CT myelography.
Immediately drain the hematoma surgically.