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Nontraumatic spinal epidural and subdural hematomas

Departments of Neurology (Drs. Mattle, Sieb, and Mumenthaler) and Neurosurgery (Dr. Rohner), University of Bern, Inseispital, Bern, Switzerland.

Ten patients with a nontraumatic spinal extramedullary hematoma are reported, nine of the hematomas localized in the epidural space. Seven of the patients were taking anticoagulant drugs and five showed signs of liver disease, mostly due to alcoholism. The invariable first symptom was an intense local pain in the spine, followed in all but one case by radicular irradiation and in all by bladder disturbances and sensory and motor deficits of the spinal cord or cauda equina. All the patients had myelography to verify the spinal mass and were operated on as fast as possible. The outcome depended mainly on the preoperative neurologic status. If there was only an incomplete sensory and motor lesion before the operation, the patients recovered fairly well or completely. The patients who did not become capable of walking again were completely paralytic preoperatively.

Address correspondence and reprint requests to Dr. Mattle, Department of Neurology, University of Bern, Inselspital, CH-3010 Bern, Switzerland.

Received August 25, 1986. Accepted for publication in final form December 4, 1986.

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