Spinal epidural hematoma

Dr Mohamed Saber and Dr Henry Knipe et al.

Spinal epidural hematomas (EDH) are a rare spinal pathology which can result in serious morbidity with delayed or non-treatment. They are typically considered a surgical emergency. 

The patient's symptoms and signs will depend on the location of the EDH, and degree of spinal cord / cauda equina compression, but invariably there will be a combination of severe pain and neurological deficit. See spinal cord injury and cauda equina syndrome for more information. 

Spinal EDH is most commonly spontaneous venous bleeds, often in the setting of coagulopathy or over-anticoagulation. They are anatomically located in what is known as the extradural neural axis compartment, located between the dura propria (visceral layer) and periosteum. 

  • spontaneous (most common 4)
    • especially in the context of a bleeding disorder or over-anticoagulation
  • trauma, e.g. vertebral fracture
  • iatrogenic, e.g. lumbar puncture, epidural anesthesia
  • spinal arteriovenous malformations or other vascular anomalies
  • spinal tumors
  • pregnancy

Spinal EDH can occur throughout the spine but is most common in the cervicothoracic region, usually posterior to the thecal sac over 2-4 vertebral levels 1,4.

  • non-contrast: hyperdense (50-70 HU) extradural mass 4

Signal characteristics will vary on the age of the blood. Signal characteristics of acute spinal EDH 1,2,5:

  • T1: isointense or hyperintense to spinal cord
  • T2: heterogeneously hyperintense to spinal cord with hypointense foci
  • T2*: blooming artifact

Article information

rID: 39884
Synonyms or Alternate Spellings:
  • Spinal extradural haemorrhage
  • Spinal epidural haemorrhage
  • Spinal EDH
  • Spinal epidural haematomas
  • Spinal epidural hematoma
  • Spinal epidural hematomas

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Cases and figures

  • Case 1: T2
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  • Case 2: T1 C+ fat sat
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  • Case 3: non-contrast CT
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  • Case 4: T2
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  • Case 5
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  • Case 6: thoracic and lumbar spine
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