Page 43 - CASA Bulletin of Anesthesiology 2019 Vol 6 No 5

Vol.6, No.5, 2019

To confirm clinical suspicion of spinal epidural hematoma, MRI is the gold standard where
possible .7 CT sometimes cannot differentiate epidural hematoma from disc herniation .

The definitive treatment of epidural hematoma is surgical decompression by laminectomy.
Outcomes are dependent on the severity of neurological deficits, and time from presentation to
surgery. 5, 8 Prognosis for recovery is over 60% if surgery is carried out with 12hr of the onset
of symptoms . But if surgery is delayed for more than 24hr after the initial symptoms, recovery

rates drop to 10% . 5

MRI sagital view of the thoracic spinal MRI axial view of the thoracic spinal
hematoma T2-T11 hematoma

References

1 . Wulf H. Epidural anesthesia and spinal hematoma. Can J Anesth 1996; 43:1260-71.
2 . Ruppen W, Derry S, McQuay H, Moore A . Incidence of epidural hematoma, infection, and neurologic injury in obstetric patients
with epidural analgesia/anesthesia. Anesthesiology 2006; 8:394-399.
3 . Al-Mutair A . Bednar DA . Spinal epidural hematoma . J Am Acad Orthop Surg 2010; 18:494-502 .
4 . Vandermeulen EP, Van Aken H, Vermylen J, et al. Anticoagulants and spinal-epidural anesthesia. Anesth Anal 1994; 79:1165-
1177 .
5 . 5 Groen RJM, Van Alphen HAM . Operative treatment of spontaneous spinal epidural hematomas: a study of the factors determin-
ing postoperative outcome. Neurosurgery 1996; 39: 494-508.
6. 6 Nam K, Seo JH, Bahk JH. Unsuspected intravascular migration of a thoracic epidural catheter in a thoracotomy patient. Anesth
Pain Med 2013; 8:184-186.
7 . 7 Ng WH, Lim CC, Ng PY, Tan KK . Spinal epidural hematoma: MRI-aided diagnosis . J Clin Neuroscience . 9:92-94, 2002 .
8 . 8 Lawton MT, Porter RW, Heiserman EJ, et al . Surgical management of spinal epidural hematoma: relationship between surgical
timing and neurological outcome . J Neurosurg 1995; 83: 1-7 .

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