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Published in: Acta Neurochirurgica 10/2009

01-10-2009 | Case Report

Vertebral artery dissection as an extremely rare cause of spinal epidural hematoma: case report and review of the literature

Authors: Zsolt Kulcsar, Zsolt Berentei, Miklos Marosfoi, Istvan Nyary, Istvan Szikora

Published in: Acta Neurochirurgica | Issue 10/2009

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Abstract

Objective

To present a patient with a cervico-thoracic ventrally located epidural hematoma caused by dissection and subsequent bleeding of the cervical portion of the vertebral artery.

Summary and background data

Non traumatic epidural hematoma is a rare entity. The etiology usually is not clarified: a venous origin is usually suspected although an arterial source is also possible.

Clinical report

A 32-year-old woman presented with a ventrally located cervico-thoracic epidural hematoma caused by non traumatic dissection and dissecting aneurysm rupture of the cervical portion of the vertebral artery. The dissection was demonstrated by magnetic resonance imaging and digital subtraction angiography. The patient had no neurological symptoms and was treated by conservative methods. Follow up imaging showed healing of the vertebral artery and resorption of the epidural hematoma.

Conclusion

Dissection of the cervical portion of the vertebral artery with subsequent perivascular bleeding is not well recognized as a possible cause of a spinal epidural hematoma. Even though this entity and the underlying cause may be rare, we suggest a vigilant search for vertebral artery injury in cases of ventrally located cervical and upper thoracic epidural hematoma.
Literature
4.
go back to reference Beatty RM, Winston KR (1984) Spontaneous cervical epidural hematoma. A consideration of etiology. J Neurosurg 61:143–148CrossRefPubMed Beatty RM, Winston KR (1984) Spontaneous cervical epidural hematoma. A consideration of etiology. J Neurosurg 61:143–148CrossRefPubMed
9.
go back to reference Crum B, Mokri B, Fulgham J (2000) Spinal manifestations of vertebral artery dissection. Neurology 55:304–306PubMed Crum B, Mokri B, Fulgham J (2000) Spinal manifestations of vertebral artery dissection. Neurology 55:304–306PubMed
12.
14.
go back to reference Groen RJ (2004) Non-operative treatment of spontaneous spinal epidural hematomas: a review of the literature and a comparison with operative cases. Acta Neurochir (Wien) 146:103–110. doi:10.1007/s00701-003-0160-9 CrossRef Groen RJ (2004) Non-operative treatment of spontaneous spinal epidural hematomas: a review of the literature and a comparison with operative cases. Acta Neurochir (Wien) 146:103–110. doi:10.​1007/​s00701-003-0160-9 CrossRef
16.
go back to reference Guillon B, Brunereau L, Biousse V, Djouhri H, Levy C, Bousser MG (1999) Long-term follow-up of aneurysms developed during extracranial internal carotid artery dissection. Neurology 53:117–122PubMed Guillon B, Brunereau L, Biousse V, Djouhri H, Levy C, Bousser MG (1999) Long-term follow-up of aneurysms developed during extracranial internal carotid artery dissection. Neurology 53:117–122PubMed
17.
go back to reference Han YM, Kwak HS, Jin GY, Chung GH, Song KJ (2006) Spinal epidural hematoma after thrombolysis for deep vein thrombosis with subsequent pulmonary thromboembolism: a case report. Cardiovasc Intervent Radiol 29:450–453. doi:10.1007/s00270-004-0133-2 CrossRefPubMed Han YM, Kwak HS, Jin GY, Chung GH, Song KJ (2006) Spinal epidural hematoma after thrombolysis for deep vein thrombosis with subsequent pulmonary thromboembolism: a case report. Cardiovasc Intervent Radiol 29:450–453. doi:10.​1007/​s00270-004-0133-2 CrossRefPubMed
21.
go back to reference Kadkhodayan Y, Jeck DT, Moran CJ, Derdeyn CP, Cross DT 3rd (2005) Angioplasty and stenting in carotid dissection with or without associated pseudoaneurysm. AJNR Am J Neuroradiol 26:2328–2335PubMed Kadkhodayan Y, Jeck DT, Moran CJ, Derdeyn CP, Cross DT 3rd (2005) Angioplasty and stenting in carotid dissection with or without associated pseudoaneurysm. AJNR Am J Neuroradiol 26:2328–2335PubMed
23.
go back to reference Lawton MT, Porter RW, Heiserman JE, Jacobowitz R, Sonntag VK, Dickman CA (1995) Surgical management of spinal epidural hematoma: relationship between surgical timing and neurological outcome. J Neurosurg 83:1–7CrossRefPubMed Lawton MT, Porter RW, Heiserman JE, Jacobowitz R, Sonntag VK, Dickman CA (1995) Surgical management of spinal epidural hematoma: relationship between surgical timing and neurological outcome. J Neurosurg 83:1–7CrossRefPubMed
25.
go back to reference Liao CC, Lee ST, Hsu WC, Chen LR, Lui TN, Lee SC (2004) Experience in the surgical management of spontaneous spinal epidural hematoma. J Neurosurg 100:38–45PubMed Liao CC, Lee ST, Hsu WC, Chen LR, Lui TN, Lee SC (2004) Experience in the surgical management of spontaneous spinal epidural hematoma. J Neurosurg 100:38–45PubMed
26.
go back to reference Miyagi Y, Miyazono M, Kamikaseda K (1998) Spinal epidural vascular malformation presenting in association with a spontaneously resolved acute epidural hematoma. Case report. J Neurosurg 88:909–911CrossRefPubMed Miyagi Y, Miyazono M, Kamikaseda K (1998) Spinal epidural vascular malformation presenting in association with a spontaneously resolved acute epidural hematoma. Case report. J Neurosurg 88:909–911CrossRefPubMed
27.
go back to reference Muller H, Schramm J, Roggendorf W, Brock M (1982) Vascular malformations as a cause of spontaneous spinal epidural haematoma. Acta Neurochir (Wien) 62:297–305. doi:10.1007/BF01403637 CrossRef Muller H, Schramm J, Roggendorf W, Brock M (1982) Vascular malformations as a cause of spontaneous spinal epidural haematoma. Acta Neurochir (Wien) 62:297–305. doi:10.​1007/​BF01403637 CrossRef
29.
go back to reference Sawin PD, Traynelis VC, Follett KA (1995) Spinal epidural hematoma following coronary thrombolysis with tissue plasminogen activator. Report of two cases. J Neurosurg 83:350–353CrossRefPubMed Sawin PD, Traynelis VC, Follett KA (1995) Spinal epidural hematoma following coronary thrombolysis with tissue plasminogen activator. Report of two cases. J Neurosurg 83:350–353CrossRefPubMed
31.
go back to reference So G, Debata A, Baba S, Tsunoda K, Suyama K, Nagata I (2008) Spontaneous cervical epidural hematoma presenting with hemiparesis following neck extension: a case report. No Shinkei Geka 36:731–734PubMed So G, Debata A, Baba S, Tsunoda K, Suyama K, Nagata I (2008) Spontaneous cervical epidural hematoma presenting with hemiparesis following neck extension: a case report. No Shinkei Geka 36:731–734PubMed
32.
go back to reference Solero CL, Fornari M, Savoiardo M (1980) Spontaneous spinal epidural haematoma arising from ruptured vascular malformation. Case report. Acta Neurochir (Wien) 53:169–174. doi:10.1007/BF02074789 CrossRef Solero CL, Fornari M, Savoiardo M (1980) Spontaneous spinal epidural haematoma arising from ruptured vascular malformation. Case report. Acta Neurochir (Wien) 53:169–174. doi:10.​1007/​BF02074789 CrossRef
34.
37.
go back to reference Yasaka M, Arihiro S, Hasegawa Y, Minematsu K (2005) A case of acute cervical epidural hematoma mimicking medial medullary infarction complicated by arterial dissection. Rinsho Shinkeigaku 45:652–656PubMed Yasaka M, Arihiro S, Hasegawa Y, Minematsu K (2005) A case of acute cervical epidural hematoma mimicking medial medullary infarction complicated by arterial dissection. Rinsho Shinkeigaku 45:652–656PubMed
Metadata
Title
Vertebral artery dissection as an extremely rare cause of spinal epidural hematoma: case report and review of the literature
Authors
Zsolt Kulcsar
Zsolt Berentei
Miklos Marosfoi
Istvan Nyary
Istvan Szikora
Publication date
01-10-2009
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 10/2009
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-009-0223-7

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