Nontraumatic spinal epidural hematoma: Report of four cases and review of the literature

OBJECTIVE AND IMPORTANCE: Spontaneous spinal epidural hematoma is a rare entity. We report four cases of nontraumatic spinal epidural hematomas observed from 1990 to 1994. CLINICAL PRESENTATION: In two cases, the causes were determined to be an acquired coagulopathy and a vascular malformation; in the other two cases, no causes were detected. We reviewed 85 cases in the literature, with particular emphasis on the various causes detected (coagulopathy, vascular malformations, tumor) and the diagnostic methods used. INTERVENTION: All the patients were investigated by computed tomography and magnetic resonance imaging and underwent surgery. CONCLUSION: We considered the expression ''nontraumatic epidural hematoma'' to be less ambiguous than ''spontaneous spinal epidural hematoma,'' which is the one that is usually used in the literature and corresponds to various definitions. In the absence of any signs suggestive of vascular malformation on magnetic resonance imaging, preoperative angiography is not essential and need not delay the surgical procedure, because the timing of the surgery, together with the preoperative clinical state, determines the quality of the clinical result.