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Spontaneous Epidural Hematoma


KEY FACTS

Terminology

  • Hemorrhage build-up between dura and spine not caused by significant trauma or iatrogenic procedures

Imaging

  • Extradural multisegmental T1 hyperintense fluid collection

  • Thoracic, lumbar > cervical

    • Lentiform or biconvex

    • Outlined by dorsal epidural fat cranially and rostrally

  • T1WI acute: < 48 hours

    • Isointense > hypo-/hyperintense

  • T1WI subacute and chronic

    • Hyperintense > isointense

  • T2WI heterogeneously hyperintense

Top Differential Diagnoses

  • Epidural metastasis

  • Lymphoma

  • Disc extrusion, migration

  • Epidural abscess

  • Subdural hematoma

  • Epidural fat lipomatosis

Pathology

  • Idiopathic: 40-50%

  • Minor trauma

  • Anticoagulation

  • Coagulopathy

  • Disc herniation

  • Vascular anomaly

Clinical Issues

  • Acute onset of neck, back pain

  • Progressive paraparesis

  • Bladder or bowel dysfunction

Sagittal T1WI MR shows an indistinct margin of the cervical cord due to an isointense mass within the dorsal epidural space
. The location of the mass is best identified at the inferior margin as extradural
.

Sagittal T2WI MR of the same patient shows a slightly heterogeneous, long-segment hyperintense mass
within the posterior epidural space spanning the C2-T4 level. The cord
is severely compressed and displaced anteriorly.

TERMINOLOGY

Abbreviations

  • Spontaneous spinal epidural hematoma (SSEDH)

Definitions

  • Accumulation of hemorrhage between dura and spine not caused by significant trauma or iatrogenic procedures

IMAGING

General Features

  • Best diagnostic clue

    • Extradural multisegmental T1 hyperintense fluid collection

  • Location

    • Thoracic, lumbar > cervical

      • –

        Cervicothoracic region more common in children

    • Dorsal > ventral > circumferential

  • Size

    • Multilevel > single level

  • Morphology

    • Broad-based

    • Lentiform or biconvex

    • Outlined by dorsal epidural fat cranially and rostrally

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