Spontaneous Thoracic Spinal Epidural Hematoma During Pregnancy

Abstract

To editor: Spontaneous spinal epidural hematoma (SSEH) is uncommon, especially during pregnancy.However, SSEH is a serious emergency that must be managed immediately to prevent permanent neurological deficit of the mother and stillbirth. The etiology and pathogenesis of SEEH remain unknown, although multiple theories and precipitating factors are described in the literature. In this report, we describe the case of a pregnant female who developed SSEH. The patient provided written and informed consent for the publication of her clinical information and associated images. Here, we report a case of a 24-year-old woman at 31weeks of gestational age, with a known factor S deficiency and positive lupus anticoagulant that was being treated with lowmolecularweight heparin (LMWH). It is possible that this treatment could have caused the hemorrhage. In addition, the patient reported a 10-day history of numbness and pain in her back, breasts and lower limbs. No history of trauma was reported. The patient presented with acute (12-hour) paraplegia and an magnetic resonance imaging (MRI) scan was immediately conducted in the local hospital, revealing acute hemorrhage in the dorsal epidural space at the T1–T3 level (Figs. 1, 2). Corticosteroids were administered, and the patient was transferred via helicopter to our emergency department, where a neurological assessment revealed impaired strength in both lower limbs (right: 3/5, left: 1/5), aswell as a loss of light touch. Cardiotocography and abdominal ultrasound revealed bradycardia with a median pulse of approximately 98 bpm on