Epidural hematoma differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Epidural hematoma in the spine
Bleeding into the epidural space in the spine may also cause epidural hematoma. These may arise spontaneously (e.g. during childbirth, or as a rare complication of anaesthesia (such as epidural anaesthesia) or surgery (such as laminectomy).
The anatomy of the epidural space means that spinal epidural hematoma has a different profile from cranial epidural hematoma. In the spine, the epidural space contains loose fatty tissue, and the epidural venous plexus, a network of large, thin-walled veins. This means that bleeding is likely to be venous. Anatomical abnormalities and bleeding disorders make these lesions more likely.
They may cause pressure on the spinal cord or cauda equina, which may present as pain, muscle weakness, or bladder and bowel dysfunction.
The diagnosis may be made on clinical appearance and time course of symptoms. It usually requires MRI scanning to confirm.
The treatment is surgical decompression.
The incidence of epidural hematoma following epidural anaesthesia is extremely difficult to quantify; estimates vary from 1 per 10,000 to 1 per 100,000 epidural anaesthetics. This means that a typical anaesthetist or anesthesiologist is statistically unlikely to cause one in a whole career.