Spinal Epidural Hematoma Related to Intracranial Hypotension
A 45-year-old female was admitted to the hospital after complaining of an orthostatic headache and cervical pain the day before. The headache occurred whenever the patient was in a sitting or standing position, but not in a supine position. She did not have a history of trauma. She was alert and did not have other neurological symptoms. There were no abnormal findings in the brain MRI.\nThe day after the patient's hospital admission, she had sudden quadriplegia and paraesthesia. The motor grade of her lower extremities was 0, and that of her upper extremities was I. The pain and high temperature on both sides were reduced, and the patient recovered with a motor grade of 3 in her upper and lower extremities. C-spine MRI was taken, and SEDH was suspected because isointensity was observed in the T1-weighted image of the epidural space from C2 to T2 while hyperintensity was observed in the T2-weighted image of the same ().\nAngiography was performed to rule out any vascular abnormality, such as arteriovenous malformation. Its result was normal. An emergency left hemilaminectomy from C4 to T1 was performed to remove the hematoma, and controlled the bleeding. During the operation, engorged epidural veins were observed, and the dura was not damaged during the operation. After the operation, the patient recovered completely from motor and sensory deficits. 6 day after surgery, myelography and computed tomography (CT) were performed due to the CSF leakage in the wound. As a high density was observed from C3 to T3 (), lumbar drainage was performed. During the lumbar puncture, the opening pressure was too low to be measured, and the lumbar drainage was minimal. The patient was treated for two weeks, for stabilization. There was increased epidural fluid collection at C2 to T3 in the spinal CT(). Second operation was thus performed, and there was no leakage at the dorsal part of the dura but there was some leakage at the C5-6 ventral part that was not found at the 1st operation. The dura defect was covered with collagen sponge (Gelfoam) and fat tissue, and sealed with adhesive sealant (Tisseel). The symptoms disappeared, and no CSF leakage was found in the follow-up myelography and spinal CT. The patient was discharged without deficits.