Spontaneous Spinal Epidural Haematomas

Spinal epidural haematomas (SEH) occur from extra-dural bleeding, most commonly after trauma, epidural anaesthesia or operative intervention. However, these also occur in arterio-vascular malformations or spontaneously without an obvious inciting event. Spontaneous spinal epidural haematomas (SSEH) are rare, with a quoted incidence of 0.1 cases per 100,000 population annually. However, these haematomas carry a significant risk of spinal cord or nerve root compression potentially resulting in permanent neurological dysfunction or death. This chapter reviews the presentation, diagnosis and treatment of SSEH in adults, pregnancy and children in order to provide clinicians with an understanding of their typical presentation, required investigations and treatment algorithms.