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Imaging and Evaluation of Spinal Hematomas: A Systematic Approach to Diagnosis. A Case Series 2005

General Spine

Guy w Takahashi, MD
Russell Barfield , MD, Non ASSR Member
Gregory Petermann , MD, ASSR Member

Purpose

The increasing number of patients on anticoagulant therapy has led to a significant rise in the number of reports and diagnoses of spinal hematoma. To our knowledge there are no recent, radiology papers describing combinations of spinal hematomas and how to differentiate the spinal compartments from each other. We present several types of hematomas in the spine, including the combination of hemorrhage in all three extra axial compartments. We will review the pertinent anatomy and present a systematic approach to these cases to help arrive at an accurate diagnosis.

Methods & Materials

Five patients who presented with pain, neurologic symptoms, and history of anticoagulant therapy all consistent with high suspicion of spontaneous spinal hematoma were evaluated with magnetic resonance imaging. There was no history of trauma. Ages varied above 50 years of age in both sexes.

Results

Findings demonstrated either isolated spinal EDH (n=1), isolated spinal SDH (n=2), and combined spinal EDH, SDH, and SAH (n=2). Diagnosing spinal hematoma requires correct differentiation of the extra-axial space and localizing the correct compartment. Although negative clinical outcomes have not been shown, inaccurate diagnosis can occur as a result of improper identification of these spaces. In general, treatment is non operative.

Conclusion

This scientific exhibit will review the three extra axial spaces of the spine including epidural, subdural, and subarachnoid that may be involved in non traumatic, anticoagulated patients with spinal hematomas and how to accurately diagnose these spaces. Multiple compartments may be involved in a single patient. A systematic approach to cases of spinal hematoma may help reduce reader variability and error, as well as ensure accurate diagnosis.