Spontaneous spinal epidural haematomas and the prognostic implications of interval to surgical decompression: a report of two cases.

Abstract

Spontaneous spinal epidural haematomas (SSEHs) are rare causes of spinal cord compression. We present 2 cases of thoracic SSEHs with similar magnetic resonance imaging (MRI) features. Patient 1 was on long-term oral anticoagulants and patient 2 had uncontrolled hypertension. Patient 1 presented with a dense motor deficit, whereas patient 2 developed progressive lower limb weakness. Decompression laminectomy and haematoma evacuation was performed 51 hours later for patient 1 and 14 hours later for patient 2. Both had recovered their lower limb power, but neurological recovery was greater for patient 2. In patients with bleeding diatheses or uncontrolled hypertension, acute SSEHs must be suspected when they present with atraumatic back pain and signs of spinal cord compression. The interval to surgical decompression greatly influences the prognosis for neurological recovery.