A Case of Acute Spontaneous Spinal Epidural Hematoma Caused by Repeated Bleeding Thoracic Radiculomeningeal Artery.

Abstract

Spontaneous spinal epidural hematoma (SSEH) presents with back pain followed by myelopathy. Venous plexus disruption is common, and arterial bleeding is extremely rare. Here, we report a case of acute spontaneous spinal epidural hematoma that showed spot sign on computed tomographic angiography and was treated. A 48-year-old woman with no medical history experienced unprovoked back pain and visited a local hospital, where she was placed under observation. Numbness gradually developed in both legs, and the patient visited our emergency room 5 hours after the onset of symptoms. Magnetic resonance imaging revealed spontaneous spinal epidural hematoma on the left ventrolateral side at the T4-6 level, and computed tomographic angiography showed a spot sign at T5-6. During the examination, the patient's paraplegia progressed, and she presented with bladder-rectum dysfunction. She was diagnosed with spinal shock and underwent emergency surgery 9 hours after the onset of symptoms. The hematoma was removed and the source of arterial bleeding was treated, generating a complete recovery. In cases of acutely progressing paraplegic spontaneous spinal epidural hematoma, contrast-enhanced computed tomographic angiography is useful for identifying the source of bleeding, and in cases of arterial bleeding, emergency decompression and vascular ligation are useful.