Spontaneous Spinal Epidural Hematoma: Correlation of Timing of Surgical Decompression and MRI Findings with Functional Neurological Outcome.

OBJECTIVE: Spontaneous spinal epidural hematomas (SSEH) are a rare and morbid entity whose prognosis is affected by delayed diagnosis and surgical intervention. Correlation with the time of intervention and neurological recovery is not clearly described in the literature. We present a retrospective study of SSEH, to determine the correlation between the timing of surgical intervention and changes in the spinal cord signal on MRI with the neurological outcome.

METHODS: The records of 14 patients who underwent surgical decompression of SSEH over 10-year duration were reviewed. The diagnosis was established on MRI scans, intraoperative findings, and in addition to the histopathological examination.

RESULTS: We identified fourteen patients in both centers, six of whom were male. The mean age was 54.1 years. The onset was spontaneous, and two patients were on anticoagulant therapy. The most common presentation was paraplegia (n=8), paraparesis (n=3) and Quadriparesis (n=2). The spinal cord signal changes on T2-weighted MRI scans were demonstrated in all studies. Response to surgery was favorable in 13 of our patients at 6-month follow up except for one patient. The spinal cord changes persisted in 5 patients on postoperative MRI scan at 6-month follow up. All patient, except for one, had a favorable neurological outcome on follow up.

CONCLUSION: Significant neurological recovery after surgical decompression of SSEH can be achieved despite the significant preoperative neurological deficits, spinal cord changes on MRI scan and delayed timing of intervention.