Tamiladu & Pondicherry Chapter of Indian Radiological and Imaging Association
Promoting the study and practice of Diagnostic Radiological Imaging Modalities in the states of Tamilnadu and Pondicherry
Answer to Quiz No. 58 dated 17 April 2016
Spinal epidural haematoma
Findings
A well defined nonenhancing lesion Is seen involving the epidural space posteriorly at the level of D1 and D2. The lesion shows peripheral T1/T2 hyperintensity with central T2 hypointensity. Spinal canal narrowing is seen with cord displacement and compression.spinal cord shows normal signal intensity. Blooming is seen on the GRE. post operative follow up MRI shows no residual bleed. patient was asymptomatic on follow up.
Discussion
Spinal epidural haematomas are a rare spinal pathology can result in serious morbidity with delayed or non-treatment. They are typically considered a surgical emergency. 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. Spinal EDH is most commonly spontaneous venous bleeds, often in the setting of coagulopathy or over-anticoagulation.other causes are trauma, iatrogenic, e.g. lumbar puncture, epidural anaesthesia, spinal AVM, spinal tumours, pregnancy. 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. absence of enhancement helps to differentiate it from extradural spinal tumours
References
radiopaedia.org. Spinal epidural haematoma. Prof Frank Gaillard and Dr Henry Knipe et al
Findings
A well defined nonenhancing lesion Is seen involving the epidural space posteriorly at the level of D1 and D2. The lesion shows peripheral T1/T2 hyperintensity with central T2 hypointensity. Spinal canal narrowing is seen with cord displacement and compression.spinal cord shows normal signal intensity. Blooming is seen on the GRE. post operative follow up MRI shows no residual bleed. patient was asymptomatic on follow up.
Discussion
Spinal epidural haematomas are a rare spinal pathology can result in serious morbidity with delayed or non-treatment. They are typically considered a surgical emergency. 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. Spinal EDH is most commonly spontaneous venous bleeds, often in the setting of coagulopathy or over-anticoagulation.other causes are trauma, iatrogenic, e.g. lumbar puncture, epidural anaesthesia, spinal AVM, spinal tumours, pregnancy. 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. absence of enhancement helps to differentiate it from extradural spinal tumours
References
radiopaedia.org. Spinal epidural haematoma. Prof Frank Gaillard and Dr Henry Knipe et al
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