A 77-year-old woman was admitted to a general medical service with rapidly progressive asymmetric leg weakness. The neurocritical care service was immediately consulted, and a history of sudden onset of severe lower back pain immediately preceding the leg weakness was reported. On examination, the patient had an asymmetric flaccid paraparesis, sensory level at T12, and urinary retention. Magnetic resonance imaging (MRI) was performed 5 hours after the symptom onset. Figure 1 shows an area of hyperintensity (bright signal) on a sagittal T2-weighted MRI displacing the spinal cord and extending from T6-7 to L2-3. The areas of decreased signal intensity likely represent the presence of deoxyhemoglobin within the acute hematoma. The lesion markedly deforms the spinal cord, as shown in the axial T2-weighted images (Figure 2), and appears as an area of relative isointensity compared with the spinal cord on T1-weighted images (Figure 3). The MRI sequences are consistent with an acute hematoma. The hematoma was evacuated 11 hours following the symptom onset. Three weeks later, the patient was walking with a 4-pronged walker. No underlying cause, such as recent trauma, spinal catheterization, or coagulopathy, was identified.
Henderson RD, Pittock SJ, Piepgras DG, Wijdicks EFM. Acute Spontaneous Spinal Epidural Hematoma. Arch Neurol. 2001;58(7):1145-1146. doi:10.1001/archneur.58.7.1145