Jornal Internacional de Medicina Física e Reabilitação
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Acute Quadriplegia Caused by Idiopathic Spontaneous Epidural Haematoma in Young Adult-Case Report and Review of Literature

Jagoš Golubovic, Tomislav Cigic, Vladimir Papic, Nenad Krajcinovic, Mladen Karan, Bojan Jelaca, Sonja Golubovic and Petar Vulekovic

Introduction: Authors tried to emphasize the importance of diagnosing and rapidly treating spontaneous spinal epidural hematoma (SSEH), a rare idiopathic condition which if not recognized early can have catastrophic consequences. The definition and pathophysiology of this condition remains controversial. Usual management consists of urgent MRI imaging followed by immediate surgical decompression.

Clinical presentation: A 22 year young adult presented with the symptoms of sudden severe chest pain, followed by weakness and numbness over the all four extremities, progressing to intense paraparesis, anesthesia and consecutively quadriplegia and sphincter control loss. MR imaging demonstrated acute epidural hematoma of cervico-thoracic spinal segments (C7-Th2) with cord compression. Idiopathic SSEH was diagnosed and prompt decompressive laminectomy with hematoma evacuation was performed. During the operation cause of bleeding was not identified. Postoperatively CTA and DSA were performed which came back negative. After 2 weeks, there was no residual weakness/parasthaesias, sphincter control was fully obtained and full motor power was required.

Discussion: SSEH in its true idiopathic form is a rare pathologic entity which can be disabling or fatal. According to the literature, most patients present with severe back and/or neck pain, often with a radicular component, followed by motor and/or sensory deficits which are symptoms to be aware of. Prompt diagnosis should be made with MRI, and evacuation of the hematoma should be immediate, ideally before the onset of neurologic signs or symptoms. As evidenced outcome depends on prompt operation timing and prognosis is impacted by age and preoperative deficit. Because of the high risk of poor outcome without treatment, SSEH should always be a diagnostic consideration in patients whose presentation is even slightly suggestive. Rapid, appropriate surgical treatment can often lead to complete recovery of function, whereas any delay in appropriate treatment can be disastrous. The role of conservative management needs to be proven and should be tailored on an individual basis.

Conclusion: SSEH is a rare and potentially fatal disease. Prompt diagnosis and surgical treatment is required to obtain good outcome results. Physicians should be aware of the early symptoms so the best treatment can be achieved.