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<meta name="DC.Title" content="Acute Spontaneous Spinal Epidural Hematomas" />
<meta name="DC.Date" content="1999-07-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Although previous reports have characterized MR imaging features of spinal epidural hematomas (EDH), few cases have been reported during the acute or hyperacute phase within the first 48 hours. Our goal in this investigation was to correlate the MR imaging features of acute (≤48 hours) spontaneous EDH with clinical management and outcome.

METHODS: Eight patients with acute spontaneous EDH (five men and three women; age range, 31−81 years) underwent MR imaging at 1.5 T (T1-weighted, n = 8; T1-weighted after the administration of 0.1 mmol/kg contrast material, n = 6; T2-weighted, n = 8; and T2*-weighted, n = 4). The interval from symptom onset to hospital admission ranged from immediate to 5 days. Two neuroradiologists reviewed the MR images for signal characteristics, contrast enhancement, and cord compression. Treatment and clinical outcome were correlated with the imaging findings.

RESULTS: The EDH were located in the cervical (n = 3), cervicothoracic (n = 2), thoracolumbar (n = 2), and lumbar (n = 1) regions. On T1-weighted images, the signal intensity of the EDH was isointense to spinal cord in five cases, hyperintense in two cases, and hypointense in one case and did not correlate with time to imaging. Isointensity on T1-weighted images persisted for 5 days in one case. On T2-weighted images, all EDHs were hyperintense with focal, heterogeneous hypointensity. Cord compression was severe in six patients, moderate in one patient, and minimal in one patient. Four cases were treated conservatively with complete resolution or improvement of symptoms within 1 to 3 weeks.

CONCLUSION: MR imaging findings were useful in establishing the diagnosis of EDH but did not influence management or predict outcome in this series. Heterogeneous hyperintensity to cord with focal hypointensity on T2-weighted images should suggest the diagnosis of acute spinal EDH. Severity of neurologic impairment had the greatest impact on management and outcome. Nonoperative treatment may be successful in cases with minimal neurologic deficits, despite cord compression revealed by MR imaging." />
<meta name="DC.Contributor" content="Melanie B. Fukui" />
<meta name="DC.Contributor" content="Amar S. Swarnkar" />
<meta name="DC.Contributor" content="Robert L. Williams" />
<meta name="article:published_time" content="1999-07-01" />
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<meta name="citation_abstract" lang="en" content="&lt;p&gt;&lt;i&gt;BACKGROUND AND PURPOSE:&lt;/i&gt; Although previous reports have characterized MR imaging features of spinal epidural hematomas (EDH), few cases have been reported during the acute or hyperacute phase within the first 48 hours. Our goal in this investigation was to correlate the MR imaging features of acute (≤48 hours) spontaneous EDH with clinical management and outcome.&lt;/p&gt;&lt;p&gt;&lt;i&gt;METHODS:&lt;/i&gt; Eight patients with acute spontaneous EDH (five men and three women; age range, 31−81 years) underwent MR imaging at 1.5 T (T1-weighted, n = 8; T1-weighted after the administration of 0.1 mmol/kg contrast material, n = 6; T2-weighted, n = 8; and T2*-weighted, n = 4). The interval from symptom onset to hospital admission ranged from immediate to 5 days. Two neuroradiologists reviewed the MR images for signal characteristics, contrast enhancement, and cord compression. Treatment and clinical outcome were correlated with the imaging findings.&lt;/p&gt;&lt;p&gt;&lt;i&gt;RESULTS:&lt;/i&gt; The EDH were located in the cervical (n = 3), cervicothoracic (n = 2), thoracolumbar (n = 2), and lumbar (n = 1) regions. On T1-weighted images, the signal intensity of the EDH was isointense to spinal cord in five cases, hyperintense in two cases, and hypointense in one case and did not correlate with time to imaging. Isointensity on T1-weighted images persisted for 5 days in one case. On T2-weighted images, all EDHs were hyperintense with focal, heterogeneous hypointensity. Cord compression was severe in six patients, moderate in one patient, and minimal in one patient. Four cases were treated conservatively with complete resolution or improvement of symptoms within 1 to 3 weeks.&lt;/p&gt;&lt;p&gt;&lt;i&gt;CONCLUSION:&lt;/i&gt; MR imaging findings were useful in establishing the diagnosis of EDH but did not influence management or predict outcome in this series. Heterogeneous hyperintensity to cord with focal hypointensity on T2-weighted images should suggest the diagnosis of acute spinal EDH. Severity of neurologic impairment had the greatest impact on management and outcome. Nonoperative treatment may be successful in cases with minimal neurologic deficits, despite cord compression revealed by MR imaging.&lt;/p&gt;" />
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<meta name="twitter:title" content="Acute Spontaneous Spinal Epidural Hematomas" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Although previous reports have characterized MR imaging features of spinal epidural hematomas (EDH), few cases have been reported during the acute or hyperacute phase within the first 48 hours. Our goal in this investigation was to correlate the MR imaging features of acute (≤48 hours) spontaneous EDH with clinical management and outcome.

METHODS: Eight patients with acute spontaneous EDH (five men and three women; age range, 31−81 years) underwent MR imaging at 1.5 T (T1-weighted, n = 8; T1-weighted after the administration of 0.1 mmol/kg contrast material, n = 6; T2-weighted, n = 8; and T2*-weighted, n = 4). The interval from symptom onset to hospital admission ranged from immediate to 5 days. Two neuroradiologists reviewed the MR images for signal characteristics, contrast enhancement, and cord compression. Treatment and clinical outcome were correlated with the imaging findings.

RESULTS: The EDH were located in the cervical (n = 3), cervicothoracic (n = 2), thoracolumbar (n = 2), and lumbar (n = 1) regions. On T1-weighted images, the signal intensity of the EDH was isointense to spinal cord in five cases, hyperintense in two cases, and hypointense in one case and did not correlate with time to imaging. Isointensity on T1-weighted images persisted for 5 days in one case. On T2-weighted images, all EDHs were hyperintense with focal, heterogeneous hypointensity. Cord compression was severe in six patients, moderate in one patient, and minimal in one patient. Four cases were treated conservatively with complete resolution or improvement of symptoms within 1 to 3 weeks.

CONCLUSION: MR imaging findings were useful in establishing the diagnosis of EDH but did not influence management or predict outcome in this series. Heterogeneous hyperintensity to cord with focal hypointensity on T2-weighted images should suggest the diagnosis of acute spinal EDH. Severity of neurologic impairment had the greatest impact on management and outcome. Nonoperative treatment may be successful in cases with minimal neurologic deficits, despite cord compression revealed by MR imaging." />
<meta name="og-title" property="og:title" content="Acute Spontaneous Spinal Epidural Hematomas" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/20/7/1365" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Although previous reports have characterized MR imaging features of spinal epidural hematomas (EDH), few cases have been reported during the acute or hyperacute phase within the first 48 hours. Our goal in this investigation was to correlate the MR imaging features of acute (≤48 hours) spontaneous EDH with clinical management and outcome.

METHODS: Eight patients with acute spontaneous EDH (five men and three women; age range, 31−81 years) underwent MR imaging at 1.5 T (T1-weighted, n = 8; T1-weighted after the administration of 0.1 mmol/kg contrast material, n = 6; T2-weighted, n = 8; and T2*-weighted, n = 4). The interval from symptom onset to hospital admission ranged from immediate to 5 days. Two neuroradiologists reviewed the MR images for signal characteristics, contrast enhancement, and cord compression. Treatment and clinical outcome were correlated with the imaging findings.

RESULTS: The EDH were located in the cervical (n = 3), cervicothoracic (n = 2), thoracolumbar (n = 2), and lumbar (n = 1) regions. On T1-weighted images, the signal intensity of the EDH was isointense to spinal cord in five cases, hyperintense in two cases, and hypointense in one case and did not correlate with time to imaging. Isointensity on T1-weighted images persisted for 5 days in one case. On T2-weighted images, all EDHs were hyperintense with focal, heterogeneous hypointensity. Cord compression was severe in six patients, moderate in one patient, and minimal in one patient. Four cases were treated conservatively with complete resolution or improvement of symptoms within 1 to 3 weeks.

CONCLUSION: MR imaging findings were useful in establishing the diagnosis of EDH but did not influence management or predict outcome in this series. Heterogeneous hyperintensity to cord with focal hypointensity on T2-weighted images should suggest the diagnosis of acute spinal EDH. Severity of neurologic impairment had the greatest impact on management and outcome. Nonoperative treatment may be successful in cases with minimal neurologic deficits, despite cord compression revealed by MR imaging." />
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      <h1 class="highwire-cite-title" id="page-title">Acute Spontaneous Spinal Epidural Hematomas</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Melanie B. Fukui</span>, <span class="highwire-citation-author" data-delta="1">Amar S. Swarnkar</span> and <span class="highwire-citation-author" data-delta="2">Robert L. Williams</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">July 1999,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">20 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(7) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1365-1372; </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-2193--61947221145" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Melanie B. Fukui </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Melanie%2BB.%2BFukui%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Fukui%20MB&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AMelanie%2BB.%2BFukui%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">Amar S. Swarnkar </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Amar%2BS.%2BSwarnkar%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Swarnkar%20AS&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AAmar%2BS.%2BSwarnkar%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">Robert L. Williams </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Robert%2BL.%2BWilliams%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Williams%20RL&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ARobert%2BL.%2BWilliams%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" xmlns:xhtml="http://www.w3.org/1999/xhtml" class="section ref-list" id="ref-list-1"><h2>References</h2><ol class="cit-list"><li><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1 in text" id="ref-1">↵</a><div class="cit ref-cit ref-other" id="cit-20.7.1365.1"><div class="cit-metadata"><cite>Holtås S, Heiling M, Lönntoft M.  <strong>Spontaneous spinal epidural hematoma. Findings at MR imaging and clinical correlation.</strong>  <span class="cit-source">Radiology</span>  <span class="cit-pub-date">1996</span>;<span class="cit-vol">199</span>:<span class="cit-fpage">409</span>-433</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=8668786&amp;link_type=MED&amp;atom=%2Fajnr%2F20%2F7%2F1365.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a><a href="/lookup/external-ref?access_num=A1996UG01100019&amp;link_type=ISI" class="cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience"><span>Web of Science</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2 in text" id="ref-2">↵</a><div class="cit ref-cit ref-other" id="cit-20.7.1365.2" data-doi="10.1016/0090-3019(81)90178-6"><div class="cit-metadata"><cite>Foo D, Rossier A.   <strong>Preoperative neurological status in predicting surgical outcome of spinal epidural hematomas.</strong>  <span class="cit-source">Surg Neurol</span>  <span class="cit-pub-date">1981</span>;<span class="cit-vol">15</span>:<span class="cit-fpage">389</span>-401</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1016/0090-3019(81)90178-6&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=9760981&amp;link_type=MED&amp;atom=%2Fajnr%2F20%2F7%2F1365.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a><a href="/lookup/external-ref?access_num=A1981LS15100021&amp;link_type=ISI" class="cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience"><span>Web of Science</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-3-1" title="View reference 3 in text" id="ref-3">↵</a><div class="cit ref-cit ref-other" id="cit-20.7.1365.3"><div class="cit-metadata"><cite>McQuarrie G.  <strong>Recovery from paraplegia caused by spontaneous spinal epidural hematoma.</strong>  <span class="cit-source">Neurology</span>  <span class="cit-pub-date">1978</span>;<span class="cit-vol">28</span>:<span class="cit-fpage">224</span>-228</cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6OToibmV1cm9sb2d5IjtzOjU6InJlc2lkIjtzOjg6IjI4LzMvMjI0IjtzOjQ6ImF0b20iO3M6MjA6Ii9ham5yLzIwLzcvMTM2NS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><div class="cit ref-cit ref-other no-rev-xref" id="cit-20.7.1365.4"><div class="cit-metadata"><cite>Packer N, Cummins B.   <strong>Spontaneous epidural hemorrhage. A surgical emergency.</strong>  <span class="cit-source">Lancet</span>  <span class="cit-pub-date">1978</span>;<span class="cit-vol">1</span>:<span class="cit-fpage">356</span>-358</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=75396&amp;link_type=MED&amp;atom=%2Fajnr%2F20%2F7%2F1365.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-5-1" title="View reference 5 in text" id="ref-5">↵</a><div class="cit ref-cit ref-other" id="cit-20.7.1365.5"><div class="cit-metadata"><cite>Groen R, Ponssen H.   <strong>The spontaneous spinal epidural hematoma. A study of the etiology.</strong>  <span class="cit-source">J Neurol Sci</span>  <span class="cit-pub-date">1990</span>;<span class="cit-vol">98</span>:<span class="cit-fpage">121</span>-138</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=2243224&amp;link_type=MED&amp;atom=%2Fajnr%2F20%2F7%2F1365.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a><a href="/lookup/external-ref?access_num=A1990EB66500001&amp;link_type=ISI" class="cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience"><span>Web of Science</span></a></div></div></li><li><div class="cit ref-cit ref-other no-rev-xref" id="cit-20.7.1365.6" data-doi="10.1002/(SICI)1097-0185(199710)249:2&lt;285::AID-AR16&gt;3.0.CO;2-K"><div class="cit-metadata"><cite>Groen RJ, Groenewegen HJ, van Alphen HA, Hoogland PV.  <strong>Morphology of the human internal vertebral venous plexus. A cadaver study after intravenous Araldite CY 221 injection.</strong>  <span class="cit-source">Anat Rec</span>  <span class="cit-pub-date">1997</span>;<span class="cit-vol">249</span>:<span class="cit-fpage">285</span>-294</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1002/(SICI)1097-0185(199710)249:2&lt;285::AID-AR16&gt;3.0.CO;2-K&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=9335475&amp;link_type=MED&amp;atom=%2Fajnr%2F20%2F7%2F1365.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><div class="cit ref-cit ref-other no-rev-xref" id="cit-20.7.1365.7" data-doi="10.1016/0736-4679(93)90247-5"><div class="cit-metadata"><cite>Joseph AP, Vinen JD.   <strong>Acute spinal epidural hematoma.</strong>  <span class="cit-source">J Emerg Med</span>  <span class="cit-pub-date">1993</span>;<span 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href="/lookup/external-ref?access_num=10.1016/0090-3019(88)90098-5&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=3400040&amp;link_type=MED&amp;atom=%2Fajnr%2F20%2F7%2F1365.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><div class="cit ref-cit ref-other no-rev-xref" id="cit-20.7.1365.9" data-doi="10.1136/pgmj.62.731.885"><div class="cit-metadata"><cite>Brawn L, Bergval U, Davies-Jones G.  <strong>Spontaneous spinal epidural haematoma with spontaneous resolution.</strong>  <span class="cit-source">Postgrad Med J</span>  <span class="cit-pub-date">1981</span>;<span class="cit-vol">62</span>:<span class="cit-fpage">885</span>-887</cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MTI6InBvc3RncmFkbWVkaiI7czo1OiJyZXNpZCI7czoxMDoiNjIvNzMxLzg4NSI7czo0OiJhdG9tIjtzOjIwOiIvYWpuci8yMC83LzEzNjUuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-10-1" title="View reference 10 in text" id="ref-10">↵</a><div class="cit ref-cit ref-other" id="cit-20.7.1365.10"><div class="cit-metadata"><cite>Gundry C, Heithoff K.   <strong>Epidural hematoma of the lumbar spine. 18 surgically confirmed cases.</strong>  <span class="cit-source">Radiology</span>  <span class="cit-pub-date">1993</span>;<span 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          <a href="/content/20/7" class="highwire-cite-linked-title" data-icon-position="" data-hide-link-title="0"><span class="highwire-cite-title">American Journal of Neuroradiology</span></a>      
      
        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 20</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 7 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Jul 1999 </div></div>
      
      
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