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Spontaneous Spinal Epidural Hematoma During Pregnancy

Published online by Cambridge University Press:  02 December 2014

Michael E.B. Kelly ,
R. Cole Beavis  and
Suzanne Hattingh
Michael E.B. Kelly*
Affiliation:
Division of Neurology, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada
R. Cole Beavis
Affiliation:
Division of Orthopaedic Surgery, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada
Suzanne Hattingh
Affiliation:
Division of Neurology, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada
*
Division of Neurosurgery, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK, Canada S7N 0W8
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Abstract:

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Background:

Spontaneous spinal epidural hematoma is a rare phenomenon that has no distinct etiology. Spontaneous spinal epidural hematoma (SSEH) during pregnancy is extremely rare. We present what we believe to be the fifth reported case of spontaneous spinal epidural hematoma associated with pregnancy in the English literature.

Methods:

A 31-year-old female presented with acute onset of paraplegia at 32 weeks of pregnancy. The patient had a T2 sensory level and complete paralysis of all lower extremity motor groups. Magnetic resonance imaging of the thoracic spine showed an acute epidural hematoma posterior to the thoracic spinal cord between the second and fourth thoracic vertebrae.

Results:

The patient was taken to the operating room were her child was delivered by caesarean section. She then underwent a posterior laminectomy and evacuation of a spinal epidural hematoma. Followup selective spinal angiography was negative for any vascular malformation. The patient gradually recovered lower extremity function and was independently ambulating at six month follow-up. Voluntary bowel and bladder function returned within four months but twice daily intermittent catheterization remained necessary for excessive post-void residual urine.

Conclusions:

Spontaneous spinal epidural hematoma in pregnancy is a rare phenomenon. It is postulated that elevated venous pressure associated with pregnancy may be a contributing factor. In the reported cases of SSEH in pregnancy most patients presented with acute symptoms, thoracic location and profound neurological deficits but, with prompt surgical treatment, generally had good long term recovery.

Résumé:

RÉSUMÉ: Introduction:

L’hématome épidural spinal spontané est un phénomène rare, sans étiologie précise, qui survient très rarement pendant la grossesse. Nous présentons ce que nous croyons être le cinquième cas rapporté d’hématome épidural spinal spontané associé à la grossesse dans la littérature de langue anglaise.

Méthodes:

Une femme âgée de 31 ans a consulté pour une paraplégie aiguë à 32 semaines de grossesse. La patiente avait un niveau sensitif situé à D2 et une paralysie complète de tous les groupes moteur au niveau des membres inférieurs. L’imagerie par résonance magnétique de la moelle épinière thoracique a révélé la présence d’un hématome épidural aigu situé derrière la moelle épinière thoracique, entre les deuxième et quatrième vertèbres thoraciques.

Résultats:

La patiente a subi une césarienne, puis on a procédé à une laminectomie postérieure et à l’évacuation de l’hématome épidural. Une angiographie n’a révélé aucune malformation vasculaire. La patiente a recouvré graduellement la fonction de ses membres inférieurs et pouvait marcher sans aide lorsqu’elle a été revue six mois plus tard. Elle a recouvré le contrôle volontaire des fonctions intestinale et vésicale en 4 mois, mais elle devait avoir recours au cathétérisme vésical deux fois par jour à cause d’un résidu vésical important.

Conclusions:

L’hématome épidural spinal spontané est un phénomène rare pendant la grossesse. Nous postulons qu’une augmentation de la pression veineuse associée à la grossesse pourrait y contribuer. Chez les cas rapportés, la plupart des patientes consultant pour des symptômes aigus et des déficits neurologiques sévères. L’hématome est généralement situé au niveau thoracique et la récupération à long terme est bonne suite à un traitement chirurgical rapide.

Type
Case Report
Information
Canadian Journal of Neurological Sciences , Volume 32 , Issue 3 , August 2005 , pp. 361 - 365
Copyright
Copyright © The Canadian Journal of Neurological 2005

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