Spontaneous spinal epidural hematoma in the setting of uncontrolled hypertension and hypertensive emergency

Abstract

Spontaneous spinal epidural hematoma (SSEH) is a neurological condition that can lead to severe deficits if it is not properly diagnosed and surgically evacuated. Due to the rarity of the disease, few cases have been reported, and the etiology poorly understood; however, identifying the risk factors associated with SSEH can allow for both a swift and accurate diagnosis, as well as better health outcomes. Here, we present two cases of SSEH with stroke-like symptoms that occurred in the setting of hypertensive emergency and uncontrolled hypertension (210/112 and 181/117, respectively). MRI confirmed diagnoses of SSEH, and subsequent hemilaminectomies were performed, resulting in significant improvement of neurological function and discharge to outpatient rehabilitation. To the best of the authors’ knowledge, we could only identify few other reports of SSEH attributed to uncontrolled hypertension. Considering that SSEH is an emergent condition requiring rapid diagnosis and surgical treatment, physicians should consider SSEH as a possible differential in hypertensive patients, particularly when presenting with stroke-like symptoms.

Keywords

• Spontaneous spinal epidural hematoma
• Stroke
• Hypertension