Spontaneous Cervical Epidural Hematoma Masquerading as an Abscess on Magnetic Resonance Imaging Scan

Ali Nourbakhsh, Gregory Chaljub, Kim J. Garges

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: The aims of the study are to describe a case of spontaneous spinal epidural hematoma (SSEH) without any predisposing factors and magnetic resonance imaging (MRI) features of epidural abscess and to highlight the importance of high clinical suspicion. Clinical Features: A 75-year-old male presented to the emergency department after a severe neck pain. He progressively showed sensory and upper motor signs on the left side of the body. The MRI scans were suggestive of cervical epidural abscess with peripheral enhancement of the lesion. Interventions and Outcomes: He underwent a multiple level (C3-T1) laminectomy when he was found to have an SSEH. There has been no history of trauma or other predisposing factor, and presence of arteriovenous malformation was ruled out by MR angiography. Conclusions: The MRI features of SSEH may be misleading and mimic other spinal lesions such as abscess. Presence of tapering superior and inferior margins, spotty Gadolinium enhancement in the mass, along with abrupt clinical onset of pain and neurologic deficit, should raise the suspicion toward epidural hematoma. Enhancement in the hyperacute stage of the hematoma itself might indicate continued bleeding and, in the case of deteriorating neurologic status, will necessitate decompression.

Original languageEnglish (US)
Pages (from-to)391-395
Number of pages5
JournalJournal of Manipulative and Physiological Therapeutics
Volume32
Issue number5
DOIs
StatePublished - Jun 2009

Fingerprint

Spinal Epidural Hematoma
Hematoma
Abscess
Epidural Abscess
Magnetic Resonance Imaging
Causality
Laminectomy
Neck Pain
Arteriovenous Malformations
Gadolinium
Neurologic Manifestations
Decompression
Nervous System
Hospital Emergency Service
Angiography
Hemorrhage
Pain
Wounds and Injuries

Keywords

  • Epidural
  • Hematoma
  • Neck Abscess
  • Spinal

ASJC Scopus subject areas

  • Chiropractics

Cite this

Spontaneous Cervical Epidural Hematoma Masquerading as an Abscess on Magnetic Resonance Imaging Scan. / Nourbakhsh, Ali; Chaljub, Gregory; Garges, Kim J.

In: Journal of Manipulative and Physiological Therapeutics, Vol. 32, No. 5, 06.2009, p. 391-395.

Research output: Contribution to journalArticle

@article{9fd174b22aa149ca870e86978f8a2567,
title = "Spontaneous Cervical Epidural Hematoma Masquerading as an Abscess on Magnetic Resonance Imaging Scan",
abstract = "Objective: The aims of the study are to describe a case of spontaneous spinal epidural hematoma (SSEH) without any predisposing factors and magnetic resonance imaging (MRI) features of epidural abscess and to highlight the importance of high clinical suspicion. Clinical Features: A 75-year-old male presented to the emergency department after a severe neck pain. He progressively showed sensory and upper motor signs on the left side of the body. The MRI scans were suggestive of cervical epidural abscess with peripheral enhancement of the lesion. Interventions and Outcomes: He underwent a multiple level (C3-T1) laminectomy when he was found to have an SSEH. There has been no history of trauma or other predisposing factor, and presence of arteriovenous malformation was ruled out by MR angiography. Conclusions: The MRI features of SSEH may be misleading and mimic other spinal lesions such as abscess. Presence of tapering superior and inferior margins, spotty Gadolinium enhancement in the mass, along with abrupt clinical onset of pain and neurologic deficit, should raise the suspicion toward epidural hematoma. Enhancement in the hyperacute stage of the hematoma itself might indicate continued bleeding and, in the case of deteriorating neurologic status, will necessitate decompression.",
keywords = "Epidural, Hematoma, Neck Abscess, Spinal",
author = "Ali Nourbakhsh and Gregory Chaljub and Garges, {Kim J.}",
year = "2009",
month = "6",
doi = "10.1016/j.jmpt.2009.04.007",
language = "English (US)",
volume = "32",
pages = "391--395",
journal = "Journal of Manipulative and Physiological Therapeutics",
issn = "0161-4754",
publisher = "Mosby Inc.",
number = "5",

}

TY - JOUR

T1 - Spontaneous Cervical Epidural Hematoma Masquerading as an Abscess on Magnetic Resonance Imaging Scan

AU - Nourbakhsh, Ali

AU - Chaljub, Gregory

AU - Garges, Kim J.

PY - 2009/6

Y1 - 2009/6

N2 - Objective: The aims of the study are to describe a case of spontaneous spinal epidural hematoma (SSEH) without any predisposing factors and magnetic resonance imaging (MRI) features of epidural abscess and to highlight the importance of high clinical suspicion. Clinical Features: A 75-year-old male presented to the emergency department after a severe neck pain. He progressively showed sensory and upper motor signs on the left side of the body. The MRI scans were suggestive of cervical epidural abscess with peripheral enhancement of the lesion. Interventions and Outcomes: He underwent a multiple level (C3-T1) laminectomy when he was found to have an SSEH. There has been no history of trauma or other predisposing factor, and presence of arteriovenous malformation was ruled out by MR angiography. Conclusions: The MRI features of SSEH may be misleading and mimic other spinal lesions such as abscess. Presence of tapering superior and inferior margins, spotty Gadolinium enhancement in the mass, along with abrupt clinical onset of pain and neurologic deficit, should raise the suspicion toward epidural hematoma. Enhancement in the hyperacute stage of the hematoma itself might indicate continued bleeding and, in the case of deteriorating neurologic status, will necessitate decompression.

AB - Objective: The aims of the study are to describe a case of spontaneous spinal epidural hematoma (SSEH) without any predisposing factors and magnetic resonance imaging (MRI) features of epidural abscess and to highlight the importance of high clinical suspicion. Clinical Features: A 75-year-old male presented to the emergency department after a severe neck pain. He progressively showed sensory and upper motor signs on the left side of the body. The MRI scans were suggestive of cervical epidural abscess with peripheral enhancement of the lesion. Interventions and Outcomes: He underwent a multiple level (C3-T1) laminectomy when he was found to have an SSEH. There has been no history of trauma or other predisposing factor, and presence of arteriovenous malformation was ruled out by MR angiography. Conclusions: The MRI features of SSEH may be misleading and mimic other spinal lesions such as abscess. Presence of tapering superior and inferior margins, spotty Gadolinium enhancement in the mass, along with abrupt clinical onset of pain and neurologic deficit, should raise the suspicion toward epidural hematoma. Enhancement in the hyperacute stage of the hematoma itself might indicate continued bleeding and, in the case of deteriorating neurologic status, will necessitate decompression.

KW - Epidural

KW - Hematoma

KW - Neck Abscess

KW - Spinal

UR - http://www.scopus.com/inward/record.url?scp=66949126041&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=66949126041&partnerID=8YFLogxK

U2 - 10.1016/j.jmpt.2009.04.007

DO - 10.1016/j.jmpt.2009.04.007

M3 - Article

C2 - 19539123

AN - SCOPUS:66949126041

VL - 32

SP - 391

EP - 395

JO - Journal of Manipulative and Physiological Therapeutics

JF - Journal of Manipulative and Physiological Therapeutics

SN - 0161-4754

IS - 5

ER -