Acute spontaneous spinal epidural hematoma - A life-threatening emergency

Abstract

Since Jackson reported the first case of Spinal Epidural Haematoma (SSEH) in 18691, some 250 cases have appeared in the literature2. We report the first case of SSEH that showed good recovery of function even after complete tetrapelgia and respiratory arrest, emphasizing the favourable outcome of surgical decompression. There have been reports of spontaneous resolution of the condition and recovery without surgical decompression3-9. Based on these reports conservative (non-' operative) management has been advocated as a valid therapeutic option for some of these cases 7·IO.Biphasic nature of the clinical course in our case (temporary resolution followed by relapse and rapid progression), also previously reported by others2, makes conservative management of apparently resolving cases risky and inappropriate. Critical review of the reports of conservatively treated SSEH shows that the indications for non- operative management of this condition are very limited and delay in surgical decompression can be catastrophiclO. Early surgical treatment of the condition confers marked prognostic advantagell.13 and conservative management, even in apparently resolving cases, should be discouraged