Complete motor recovery after acute paraparesis caused by spontaneous spinal epidural hematoma: case report

• Published in: BMC emergency medicine Vol. 11; no. 1; p. 10
• Main Authors: Taniguchi, Leandro U, Pahl, Felix H, Lúcio, José E D, Brock, Roger S, Gomes, Marcos Q T, Adoni, Tarso, Fiorini, Victor C C, Carvalho, Rodrigo C, Evaristo, Eli F, Mutarelli, Eduardo G, Schettino, Guilherme
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 27.07.2011; BioMed Central; BMC
• Subjects: Acute Disease; Adult; Care and treatment; Case Report; Case studies; Complications and side effects; Diagnosis; Diagnosis, Differential; Epidural hematoma; Hematoma, Epidural, Spinal - complications; Hematoma, Epidural, Spinal - diagnosis; Hematoma, Epidural, Spinal - pathology; Hematoma, Epidural, Spinal - surgery; Humans; Laminectomy; Magnetic Resonance Imaging; Male; Paraparesis - diagnosis; Paraparesis - etiology; Risk factors; Skin diseases; Thoracic Vertebrae; Brazil
• ISSN: 1471-227X; 1471-227X
• DOI: 10.1186/1471-227X-11-10

Spontaneous spinal epidural hematoma is a relatively rare but potentially disabling disease. Prompt timely surgical management may promote recovery even in severe cases. We report a 34-year-old man with a 2-hour history of sudden severe back pain, followed by weakness and numbness over the bilateral lower limbs, progressing to intense paraparesis and anesthesia. A spinal magnetic resonance imaging scan was performed and revealed an anterior epidural hematoma of the thoracic spine. He underwent an emergency decompression laminectomy of the thoracic spine and hematoma evacuation. Just after surgery, his lower extremity movements improved. After 1 week, there was no residual weakness and ambulation without assistance was resumed, with residual paresthesia on the plantar face of both feet. After 5 months, no residual symptoms persisted. The diagnosis of spontaneous spinal epidural hematoma must be kept in mind in cases of sudden back pain with symptoms of spinal cord compression. Early recognition, accurate diagnosis and prompt surgical treatment may result in significant improvement even in severe cases.