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ISSN 0185-3252 (Print)
Revista de la Asociación Médica del Centro Médico ABC

2014, Number 4

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An Med Asoc Med Hosp ABC 2014; 59 (4)

Cauda equina syndrome secondary to a spontaneous epidural hematoma. Case presentation

Callejas PE, Rodríguez CRE

Language: Spanish
References: 18
Page: 304-309
PDF size: 269.58 Kb.


ABSTRACT

Introduction: Spontaneous epidural hematoma is a rare clinical disorder characterized by accumulation of blood in the epidural space of unknown etiology. This causes mechanical compression to the spine cord, and can even cause a non-temporal neurological deficit as a cauda equina syndrome. Presentation of a case: We present the case of a 56-year-old male patient, chronic user of acetilsalicilic acid, that after a Valsalva maneuver began with lumbalgia irradiated to the pelvic extremities and impaired sensation, weakness, absence of tendon reflexes and acute urinary retention. The patient had a magnetic resonance imaging of the lumbar spine that revealed an epidural hematoma in the lumbar region. He was treated with a surgical posterior decompression. Conclusions: The spontaneous epidural hematoma is a rare condition that usually presents with severe and acute pain at the site of the hemorrhage and irradiation to the pelvic limbs; it can develop an acute, fast and progressive neurological deficit. The pathophysiology remains unclear. However, the most accepted theory on the etiology of the epidural hematoma in the lumbar spine is the internal rupture of the Batson vertebral venous plexus. Clinical evaluation is the most important tool in early diagnosis. Magnetic resonance imaging is the gold standard for the diagnosis of spontaneous epidural hematoma. Symptomatic spontaneous epidural hematoma is typically managed with urgent surgical decompression of the spinal canal, regardless the cause.


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