Spontaneous spinal epidural hematoma. Case report.

H EMATOMA of the spinal epidural space arising in the a p p a r e n t absence of significant t r a u m a or o ther cause is an uncommon event. Al though this rare lesion m a y occur a t any age, there have been only five pat ients repor ted whose age was less than ~0 years. 3,5 In one of these, a fall of 3 feet was reported, 6 while in ano ther no history was obtainable; therefore, the classification of these two cases as " spon taneous" is at least debatable. We are repor t ing an additional case. Case Report History. H. C., a 14-year-old white girl, while in the act of voiding, experienced sudden severe pain in the back of her neck, associated with diffuse numbness of both arms. Because of the pain she lay down on the ba th room floor for several minutes, then rose, walked a short dis tance to her bedroom, and again lay down, complaining to her parents of her neck pain. While resting she noticed the onset of progressive weakness of bo th arms and legs, occurring over a period of several minutes, and steadi ly increasing. Medical help was sought, and the pat ient was referred to the Lawrence and Memorial I Iospi ta ls approx imate ly 3 hours af ter the initial symptoms had begun. She s ta ted tha t during the pas t yea r she had had mild difficul ty initiating her u r ina ry s t ream. On specific questioning she also recalled tha t during the preceding week she had been aware of some neck discomfort . There were no other premoni tory symptoms . Examination. The pa t i en t was a heal thyappear ing adolescent, lying quiet ly, bu t complaining of neck pain. General examinat ion disclosed no evidence of t r a u m a or other abnormali t ies, except for abdominal respirations. There was modera t e bu t definite resistance to neck flexion. Neurological evaluat ion revealed a profound quadriparesis; m o v e m e n t was ent irely absen t in the legs, hands, and forearms. Feeble external rotation of both a rms was the only voluntary mo to r function demons t rab le below the neck.