Cervical EDH is a rare pathological entity, which is usually detected by MRI after a cervical fracture and dislocation or in patients with ankylosing spondylitis or a coagulation abnormality.
2) Post-traumatic EDH is considered more uncommon compared to spontaneous EDH. The initial clinical manifestations of spinal EDH are back and neck pain, and eventually, compressive myelopathy symptoms. The exact cause of spinal EDH is unknown, but it has been associated with hypertension, anticoagulation, elevated venous pressure, pregnancy, trauma, and vascular malformation.
913) In our case, there were no osseous lesions or associated disc bulge, as well as no factors favouring bleeding such as hypertension, arteriovenous malformations, anticoagulant treatment or coagulopathy. No interspinous ligament or spinal muscle rupture was noted preoperatively and intraoperatively. In most cases, the hematoma is located on the dorsal aspect of the spinal cord, which has led to the belief that the posterior epidural venous plexus is the main source of spinal EDH.
11) Rupture in the venous plexus during the hyperflexion and hyperextension injury is believed to be caused by reversal of venous flow when intrathoracic or intra-abdominal pressure increases due to excessive strain. The veins in this plexus do not have valves and are vulnerable to rupture by abrupt changes in venous pressure. Also, the rapidity of development of a cervical EDH points toward its arterial origin due to free anastomotic arteries running in the epidural space that also connect with radicular arteries.
4) Although degrees of symptoms vary from mild motor or sensory deficit to serious sphincter deficits, spinal EDH can rapidly compromise the spinal cord and result in paralysis or acute deterioration with severe neurologic deficits. Therefore, prompt diagnosis and the determination of hematoma extent are essential.
8) Early diagnosis requires clinical suspicion and immediate imaging, and MRI is considered the diagnostic technique of choice. T1-weighted images are most useful due to the signal shift from isointensity with respect to the cord during the early period to hyperintensity in the subacute stage. T2-weighted images are useful for differential diagnosis during the early stage because they can show characteristic focal signal intensity caused by deoxyhemoglobin. The initial clinical features of cervical EDH are neck pain, chest pain, hemiparesis, and sciatic pain with or without subsequent myelopathy. It can resemble those of an acutely ruptured cervical disc, epidural neoplasia, transverse myelitis, acute ischemic stroke, cardiac ischemia, or epidural abscess.
7) Spontaneous resolution of spinal EDH without surgery has been reported when neurological deficits are not severe and in cases of rapid clinical improvement.
16) However, the treatment of choice for symptomatic cervical EDH is prompt surgical evacuation of the hematoma following laminectomy, and usually achieves favorable results. In general, the earlier the operation, the better the neurological outcome achieved.
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