spinal epidural hematoma

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Spinal epidural hematomas (EDH) are a rare spinal pathology which can result in serious morbidity with delayed or non-treatment. They are typically considered a surgical emergency.

Clinical presentation

The patient's symptoms and signs will depend on the location of the EDH, and degree of spinal cord / cauda equina compression, but invariably there will be a combination of severe pain and neurological deficit. See spinal cord injury and cauda equina syndrome for more information.

Pathology

Spinal EDH is most commonly spontaneous venous bleeds, often in the setting of coagulopathy or over-anticoagulation. They are anatomically located in what is known as the extradural neural axis compartment, located between the dura propria (visceral layer) and periosteum.

Etiology

spontaneous (most common )
- especially in the context of a bleeding disorder or over-anticoagulation
trauma, e.g. vertebral fracture
iatrogenic, e.g. lumbar puncture, epidural anesthesia
spinal arteriovenous malformations or other vascular anomalies
spinal tumors
pregnancy

Location

Spinal EDH can occur throughout the spine but is most common in the cervicothoracic region, usually posterior to the thecal sac over 2-4 vertebral levels .