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Neurochirurgie
Volume 65, n° 1
pages 27-31 (février 2019)
Doi : 10.1016/j.neuchi.2018.10.008
Received : 12 May 2018 ;  accepted : 6 October 2018
Revue Générale

Spontaneous resolution and complete recovery of spontaneous cervical epidural hematoma: Report of two cases and literature review
 

B. Zhang a, 1, J. Chen b, 1, N. Zou a, 1, L. Wang a, H. Wang a, J. Jiang a, D. Chen a, , X. Lu a,
a Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, No. 415, Feng Yang Street, Huangpu District, Shanghai 200003, China 
b Department of Neurosurgery, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China 

Corresponding authors.
Abstract
Objective

To present the natural course and treatment modalities of spontaneous cervical epidural hematoma (SCEH), by reporting two rare cases with spontaneous resolution in both clinical and radiologic findings without surgery.

Material and methods

One patient presenting with acute right side hemiparesis and another showing pure cervical radiculopathy were diagnosed with SCEH on magnetic resonance imaging (MRI). Both were both treated non-operatively. We also conducted a literature review of 19 cases of spontaneous spinal epidural hematoma (SSEH).

Results

These two patients achieved complete resolution in terms of both neurologic function and radiologic findings within 21 days after onset. In the literature review, 63.2% of cases experienced neurologic improvement in the first 24h, 78.9% achieved complete neurologic recovery within 1 month, and radiological images showed complete resolution of hematoma in the first month for 73.7% of patients.

Conclusions

Atypical cervical SSEH can mimic cerebral stroke or a ruptured cervical disc. A high index of clinical suspicion followed by MRI examination is critical for diagnosis. Prompt surgical decompression and evacuation of the hematoma is generally regarded as first-line treatment. However, for patients without or with only slight neurologic symptoms, or showing early and sustained neurologic improvement, non-surgical therapy with close observation is a viable alternative. Both neurologic and radiologic resolution can be expected within the first month following onset in most cases of spontaneous resolution of SSEH.

The full text of this article is available in PDF format.

Keywords : Spontaneous spinal epidural hematoma, Hemiparesis, Radiculopathy, Spontaneous resolution


1  B. Zhang, J. Chen and N. Zou are co-first authors.


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