SPINAL EPIDURAL HEMATOMA - REPORT OF 11 CASES AND REVIEW OF THE LITERATURE

Spinal epidural haematomas (SEH) are rare; most are caused by trauma, anticoagulant therapy, vascular anomalies, hypertension, blood dyscras ias, epidural anaesthesia or, rarely, spinal surgery. We report 11 cas es and review the literature (16 cases). The clinical picture is that of acute spinal cord compression. MRI characteristics are quite specif ic. On sagittal sections, the SEH appears as a biconvex mass, dorsal t o the thecal sac, clearly outlined and with tapering superior and infe rior margins. The dura mater is seen as curvilinear low signal separat ing the haematoma from the cord. Within 24 h of onset, the haematoma i s isointense with the cord on T1-weighted images and heterogeneous on T2-weighted images. Later, it gives high signal on both T1- and T2-wei ghted images. Differential diagnosis must include subdural haematoma, epidural neoplasm and abscess. Complete neurological recovery rapidly follows laminectomy and removal of the clot. In three of our cases, th e haematoma resolved spontaneously. MRI is the best examination for di agnostic and follow-up.