Case Archives — Dorsal Spinal Epidural Hematoma

The majority of spinal epidural hematomas are felt to be venous.  Here is a case of a man who presented with complete lower extremity plegia following cardiac surgery.  A large epidural hematoma (white arrows), to the right of the median raphe, displaces the dura (black arrows) and narrows the spinal canal (yellow)

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The patient is taken for emergent surgical decompression.  Angiogram post-decompression demonstrates contrast extravasation from a dorsal epidural branch of the left T11 segmental artery.

The hemorrhage is slightly to the right of midline

Oblique view

Post-nBCA

CT post nBCA shows cast in the dorsal epidural space (black arrows) and in the paraspinal musculature (white arrows)

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It is impossible to know whether the findings reflect post-surgical arterial injury or primary hemorrhage.  But I think it is worth looking at.  Certainly, the dorsal epidural venous plexus is usually less vascular than the ventral one, yet here the branches are quite large