Thoracic Spinal Epidural Hematoma [Neurosurgery Wiki]

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====== Thoracic Spinal Epidural Hematoma ======

A **Thoracic [[Spinal Epidural Hematoma]] (TSEH)** is a rare condition involving blood accumulation in the **epidural space** of the thoracic spine, which may compress the spinal cord and cause acute neurological deficits.

===== 🧠 Definition =====
A collection of blood between the **dura mater** and the **vertebral wall** in the **thoracic spinal canal**.

===== 📊 Epidemiology =====
  * **Incidence**: ~0.1 per 100,000/year (all SEH); thoracic less common.
  * **Age**: More frequent in adults >40 years.
  * **Gender**: Slight male predominance.

===== ⚠️ Etiology / Risk Factors =====
  * **[[Spontaneous Thoracic Spinal Epidural Hematoma]]** (idiopathic, coagulopathy, vascular malformations)
  * **Traumatic** (even minor trauma or spinal manipulation)
  * **Iatrogenic** (epidural injection, lumbar puncture)
  * **Neoplastic or infectious** (rare)

===== 🔍 Clinical Presentation =====
  * **Acute thoracic back pain**
  * **Motor deficits**: paraparesis or paraplegia
  * **Sensory level** loss
  * **Sphincter dysfunction**
  * May mimic:
    * Aortic dissection
    * Stroke
    * Transverse myelitis

===== 🧪 Diagnosis =====
  * **MRI spine with contrast**: gold standard
    * Identifies epidural blood compressing spinal cord
  * **CT**: less sensitive; useful for bony abnormalities
  * **Spinal angiography**: if vascular lesion suspected

===== ⚒️ Management =====
  * **Urgent surgical decompression** (laminectomy)
    * Especially if deficits are severe or worsening
  * **Conservative** management:
    * Only in stable or improving patients
  * **Correct coagulation disorders**

===== 📈 Prognosis =====
  * Best outcomes if surgery within **12 hours**
  * Prognosis depends on pre-op neurological status and delay to treatment

===== 📚 Key Points =====
  * Acute thoracic back pain + neurological signs = emergency MRI
  * Delay in diagnosis/treatment → permanent damage
  * Early decompression = key to neurological recovery