SPONTANEOUS SPINAL EPIDURAL HEMATOMA WITH SPINAL-CORD COMPRESSION COMPLICATING PLASMA-CELL MYELOMA - A CASE-REPORT

Study Design. A case is reported in which a patent had acute paraplegi a with sensory loss caused by a spontaneous epidural hematoma that was ascribed to bleeding of pre-existing myeloma lesions of the thoracic vertebrae. Objectives. To highlight the causes of secondary epidural h ematomas with special attention to pre-existing vertebral or vertebral lesions. Summary of Background Data. There are no apparent previous r eports of epidural spinal hematomas ascribed to underlying malignant d iseases. Benign dysplasia, such as hemangioma or Paget's disease, has been implicated in a few cases. Methods. A case of spontaneous dorsal epidural hematoma is reported in a patient followed up for plasma cell myeloma with osteolytic lesions in the lower thoracic spine. There wa s no history of major trauma or coagulation disorders. Complete loss o f motor and sensory function in both lower limbs was noted, with sphin cter dysfunction. Magnetic resonance imaging of the thoracic spine sho wed a large posterolateral epidural hematoma responsible for spinal co rd compression. Results. The patient failed to improve despite surgica l decompression within 6 hours of symptom onset. Hew died 13 days late r of refractory bacterial pneumonia. A large epidural hematoma adjacen t to myelomatous lesions of the thoracic vertebrae was found at autops y. Conclusions. This is the first reported case of spontaneous epidura l hematoma ascribed to underlying malignant disease, with confirmation of the diagnosis by postmortem examination. Possible mechanisms inclu de tumor-related epidural inflammation and fragility of epidural venou s plexuses.