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.

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

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

• 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)

• Acute thoracic back pain
• Motor deficits: paraparesis or paraplegia
• Sensory level loss
• Sphincter dysfunction
• May mimic:
  • Aortic dissection
  • Stroke
  • Transverse myelitis

• 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

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

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

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