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A Case of Acute Cervical Spinal Epidural Hematoma Caused by Extradural Arterio-venous Malformation Shoji TAKANO 1 , Motoyoshi SAITOH 1 , Tadashi MOTOORI 2 , Yoshio MIYASAKA 2 , Kenzoh YADA 3 , Hiroshi TAKAGI 4 1Department of Neurosurgery, Kitasato Institute Medical Center Hospital 2Department of Pathology, Kitasato Institute Medical Center Hospital 3Department of Neurosurgery, Kitasato University School of Medicine 4Department of Neurosurgery, Yamato City Hospital Keyword: Extradural arterio-venous malformation , Cervical spine , Acute spinal epidural hematoma pp.845-849
Published Date 1994/9/10
DOI https://doi.org/10.11477/mf.1436900903
  • Abstract
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The authors report a rare case of acute cervical epidural hematoma caused by the hemorrhage from ex-tradural arterio-venous malformation. The patient was a 74-year-old Japanese man with a past history of total gastrectomy after being diagnosed as having gastric cancer 12 years before. Six hours prior to admission, the patient had experienced a sudden episode of severe nuchal pain radiating to both scapular areas, followed by rapid development of left-side Brown-Sequard Syn-drome below the C4 cord level, and urinary inconti-nence. Plain cervical X-ray films did not show any des-tructive lesion suggesting a metastatic tumor. T1 and T2 weighted images of MRI demonstrated a high in-tensity mass lesion, suggesting an acute epidural hema-toma, extending from C3 to C6 and compressing se-verely the left side spinal cord posteriorly. Twelve hours after the onset of symptoms, emergen-cy laminectomy from C3 to C6 was performed and a fresh epidural clot with small vascular tissue was total-ly removed. Histological examination of the small vascular tissue in the hematoma revealed arterio-venous malformation. The postoperative recovery of the pa-tient was dramatic. He regained full muscle strength and there was complete disappearance of sensory de-ficits 2 weeks after the operation.

Although acute spinal epidural hematoma caused by extradural arterio-venous malformation is a rare clinical entity, MRI is the most helpful diagnostic tool for this condition. It should be stressed that accurate neuro-radiological diagnosis and prompt surgical decompres-sion of the spinal cord are essential to obtain an excel-lent surgical outcome.


Copyright © 1994, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院

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