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Epidural Hematoma, Craniovertebral Junction
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Epidural hematoma (EH)
            • Definitions

              • Accumulation of hemorrhage between dura and spine
                • Most common cause is significant trauma or iatrogenic procedures

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Nonvascular Interventions

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Aono H et al: Incidence of postoperative symptomatic epidural hematoma in spinal decompression surgery. J Neurosurg Spine. 15(2):202-5, 2011
                                          2. Glotzbecker MP et al: Postoperative spinal epidural hematoma: a systematic review. Spine (Phila Pa 1976). 35(10):E413-20, 2010
                                          3. Cramer DE et al: Major neurologic deficit immediately after adult spinal surgery: incidence and etiology over 10 years at a single training institution. J Spinal Disord Tech. 22(8):565-70, 2009
                                          4. Kitagawa RS et al: Paraspinal arteriovenous malformations in children. J Neurosurg Pediatr. 3(5):425-8, 2009
                                          5. Rois PV et al: Spinal epidural hematoma in hemophilic children: controversies in management. Childs Nerv Syst. 25(8):987-91; discussion 993, 995, 2009
                                          6. Xu R et al: Epidural steroid injection resulting in epidural hematoma in a patient despite strict adherence to anticoagulation guidelines. J Neurosurg Spine. 11(3):358-64, 2009
                                          7. Sokolowski MJ et al: Prospective study of postoperative lumbar epidural hematoma: incidence and risk factors. Spine (Phila Pa 1976). 33(1):108-13, 2008
                                          8. Liao CC et al: Experience in the surgical management of spontaneous spinal epidural hematoma. J Neurosurg. 100(1 Suppl):38-45, 2004
                                          9. Dorsay TA et al: MR imaging of epidural hematoma in the lumbar spine. Skeletal Radiol. 31(12):677-85, 2002
                                          10. Nawashiro H et al: Contrast enhancement of a hyperacute spontaneous spinal epidural hematoma. AJNR Am J Neuroradiol. 22(7):1445, 2001
                                          11. Duffill J et al: Can spontaneous spinal epidural haematoma be managed safely without operation? A report of four cases. 69(6):816-9, 2000
                                          12. Kuker W et al: Spinal subdural and epidural haematomas: diagnostic and therapeutic aspects in acute and subacute cases. Acta Neurochir (Wien). 142(7):777-85, 2000
                                          13. Fukui MB et al: Acute spontaneous spinal epidural hematomas. AJNR Am J Neuroradiol. 20(7):1365-72, 1999
                                          14. Sklar EM et al: MRI of acute spinal epidural hematomas. J Comput Assist Tomogr. 23(2):238-43, 1999
                                          15. Alexiadou-Rudolf C et al: Acute nontraumatic spinal epidural hematomas. An important differential diagnosis in spinal emergencies. Spine. 23(16):1810-3, 1998
                                          16. Patel H et al: Spontaneous spinal epidural hematoma in children. Pediatr Neurol. 19(4):302-7, 1998
                                          17. Chen CJ et al: Imaging findings of spontaneous spinal epidural hematoma. J Formos Med Assoc. 96(4):283-7, 1997
                                          18. Groen RJ et al: Operative treatment of spontaneous spinal epidural hematomas: a study of the factors determining postoperative outcome. Neurosurgery. 39(3):494-508; discussion 508-9, 1996
                                          19. Holtas S et al: Spontaneous spinal epidural hematoma: findings at MR imaging and clinical correlation. Radiology. 199(2):409-13, 1996
                                          20. Lawton MT et al: Surgical management of spinal epidural hematoma: relationship between surgical timing and neurological outcome. J Neurosurg. 83(1):1-7, 1995
                                          21. Gundry CR et al: Epidural hematoma of the lumbar spine: 18 surgically confirmed cases. Radiology. 187(2):427-31, 1993
                                          22. Groen RJ et al: The spontaneous spinal epidural hematoma. A study of the etiology. J Neurol Sci. 98(2-3):121-38, 1990
                                          23. Rothfus WE et al: MR imaging in the diagnosis of spontaneous spinal epidural hematomas. J Comput Assist Tomogr. 11(5):851-4, 1987
                                          24. Levitan LH et al: Chronic lumbar extradural hematoma: CT findings. Radiology. 148(3):707-8, 1983
                                          25. Foo D et al: Preoperative neurological status in predicting surgical outcome of spinal epidural hematomas. Surg Neurol. 15(5):389-401, 1981
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Clinical Issues

                                                    TERMINOLOGY

                                                    • Abbreviations

                                                      • Epidural hematoma (EH)
                                                    • Definitions

                                                      • Accumulation of hemorrhage between dura and spine
                                                        • Most common cause is significant trauma or iatrogenic procedures

                                                    IMAGING

                                                    • General Features

                                                      • Radiographic Findings

                                                        • CT Findings

                                                          • MR Findings

                                                            • Nonvascular Interventions

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Staging, Grading, & Classification

                                                                      • Gross Pathologic & Surgical Features

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              • Treatment

                                                                                DIAGNOSTIC CHECKLIST

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Aono H et al: Incidence of postoperative symptomatic epidural hematoma in spinal decompression surgery. J Neurosurg Spine. 15(2):202-5, 2011
                                                                                  2. Glotzbecker MP et al: Postoperative spinal epidural hematoma: a systematic review. Spine (Phila Pa 1976). 35(10):E413-20, 2010
                                                                                  3. Cramer DE et al: Major neurologic deficit immediately after adult spinal surgery: incidence and etiology over 10 years at a single training institution. J Spinal Disord Tech. 22(8):565-70, 2009
                                                                                  4. Kitagawa RS et al: Paraspinal arteriovenous malformations in children. J Neurosurg Pediatr. 3(5):425-8, 2009
                                                                                  5. Rois PV et al: Spinal epidural hematoma in hemophilic children: controversies in management. Childs Nerv Syst. 25(8):987-91; discussion 993, 995, 2009
                                                                                  6. Xu R et al: Epidural steroid injection resulting in epidural hematoma in a patient despite strict adherence to anticoagulation guidelines. J Neurosurg Spine. 11(3):358-64, 2009
                                                                                  7. Sokolowski MJ et al: Prospective study of postoperative lumbar epidural hematoma: incidence and risk factors. Spine (Phila Pa 1976). 33(1):108-13, 2008
                                                                                  8. Liao CC et al: Experience in the surgical management of spontaneous spinal epidural hematoma. J Neurosurg. 100(1 Suppl):38-45, 2004
                                                                                  9. Dorsay TA et al: MR imaging of epidural hematoma in the lumbar spine. Skeletal Radiol. 31(12):677-85, 2002
                                                                                  10. Nawashiro H et al: Contrast enhancement of a hyperacute spontaneous spinal epidural hematoma. AJNR Am J Neuroradiol. 22(7):1445, 2001
                                                                                  11. Duffill J et al: Can spontaneous spinal epidural haematoma be managed safely without operation? A report of four cases. 69(6):816-9, 2000
                                                                                  12. Kuker W et al: Spinal subdural and epidural haematomas: diagnostic and therapeutic aspects in acute and subacute cases. Acta Neurochir (Wien). 142(7):777-85, 2000
                                                                                  13. Fukui MB et al: Acute spontaneous spinal epidural hematomas. AJNR Am J Neuroradiol. 20(7):1365-72, 1999
                                                                                  14. Sklar EM et al: MRI of acute spinal epidural hematomas. J Comput Assist Tomogr. 23(2):238-43, 1999
                                                                                  15. Alexiadou-Rudolf C et al: Acute nontraumatic spinal epidural hematomas. An important differential diagnosis in spinal emergencies. Spine. 23(16):1810-3, 1998
                                                                                  16. Patel H et al: Spontaneous spinal epidural hematoma in children. Pediatr Neurol. 19(4):302-7, 1998
                                                                                  17. Chen CJ et al: Imaging findings of spontaneous spinal epidural hematoma. J Formos Med Assoc. 96(4):283-7, 1997
                                                                                  18. Groen RJ et al: Operative treatment of spontaneous spinal epidural hematomas: a study of the factors determining postoperative outcome. Neurosurgery. 39(3):494-508; discussion 508-9, 1996
                                                                                  19. Holtas S et al: Spontaneous spinal epidural hematoma: findings at MR imaging and clinical correlation. Radiology. 199(2):409-13, 1996
                                                                                  20. Lawton MT et al: Surgical management of spinal epidural hematoma: relationship between surgical timing and neurological outcome. J Neurosurg. 83(1):1-7, 1995
                                                                                  21. Gundry CR et al: Epidural hematoma of the lumbar spine: 18 surgically confirmed cases. Radiology. 187(2):427-31, 1993
                                                                                  22. Groen RJ et al: The spontaneous spinal epidural hematoma. A study of the etiology. J Neurol Sci. 98(2-3):121-38, 1990
                                                                                  23. Rothfus WE et al: MR imaging in the diagnosis of spontaneous spinal epidural hematomas. J Comput Assist Tomogr. 11(5):851-4, 1987
                                                                                  24. Levitan LH et al: Chronic lumbar extradural hematoma: CT findings. Radiology. 148(3):707-8, 1983
                                                                                  25. Foo D et al: Preoperative neurological status in predicting surgical outcome of spinal epidural hematomas. Surg Neurol. 15(5):389-401, 1981