Traumatic Spinal Epidural Hematoma Associated with Severe Head Injury Case Report

Abstract

A 17-year-old male was hit by a car while driving a motorcycle and suffered multiple injuries, including facial lacerations, black eyes, and blunt trauma to the anterior chest wall. X-ray films showed fractures of the skull, the left clavicle, and the right scapula, but the pelvis and the vertebrae were negative for fracture. A CT scan of the brain showed an acute epidural hematoma. As signs of cord compression appeared gradually, a metrizamide myelography and a metrizamide CT scan were performed. Myelography disclosed a partial block at the T3-4 level. The metrizamide CT scan showed fracture of the T2 lamina and an epidural mass lesion of low density which displaced the spinal column to the left-anterior. Nine days after admission, decompressive laminectomy was performed with findings of blood clots mixed with fat tissue in the extradural space from Tl to T4. Three months after the operation, he was able to walk with clear consciousness and full bladder control. A traumatic spinal epidural hematoma is a rare clinical entity. Most of the 20 spinal epidural hematomas collected from the literature showed back pain, progressive flaccid paraplegia or tetraplegia, sensory disturbance, and urinary retention. It should be worth while to perform surgical decompression 24 or even more hours after the onset, if development of paraplegia is slow and incomplete. © 1984, The Japan Neurosurgical Society. All rights reserved.