Published: 2021-07-28

Spontaneous lumbo-sacral epidural hematoma presenting as Cauda Equina syndrome: a case report

Mohammad Sarwar, Laxminarayan Tripathy, Kalyanbrata Bhattacharyya


Spinal epidural hematoma (SEH) is a rare condition and it accounts for less than 1% of all spinal canal space occupying conditions. Spontaneous SEH most commonly occurs in the cervical and thoracic regions. They present with neck or back pain with radiculopathy and/ or myelopathy. Early surgical decompression is the recommended treatment in the presence of progressive neurological deficits. Spontaneous SEH (SSEH) presenting as Cauda Equina syndrome (CES) are rarely reported in the literature. We present a case of SSEH presenting late with CES. Due to delay in presentation and multiple co-morbidities, patient was treated conservatively.


Spontaneous spinal epidural hematoma, Cauda equina syndrome, Lumbo-sacral hematoma

Full Text:



Al-Mutair A, Bednar DA. Spinal epidural hematoma. J Am Acad Orthop Surg. 2010;18:494-502.

Lawton MT, Porter RW, Heiserman JE, Jacobowitz R, Sonntag VK, Dickman CA. Surgical management of spinal epidural hematoma: relationship between surgical timing and neurological outcome. J Neurosurg. 1995;83(1):1-7.

Ruelle A, Datti R, Pisani R. Thoracic epidural hematoma after spinal manipulation therapy. J Spinal Disord. 1999;12(6):534-6.

Cabana F, Pointillart V, Vital J, Sénégas J. Hématorrachisouhématome extradural rachidien (HER) postopératoirecompressif. Etude de 15 cas et revue de la littérature [Postoperative compressive spinal epidural hematomas. 15 cases and a review of the literature]. Rev Chir Orthop Reparatrice Appar Mot. 2000;86(4):335-45.

Kostuik J. Cauda equina syndrome. Neurosurg Focus. 2004;16.

Fleager K, Lee A, Cheng I, Hou L, Ryu S, Boakye M. Massive spontaneous epidural hematoma in a high-level swimmer: a case report. J Bone Joint Surg Am. 2010;92(17):2843-6.

Cheng X, Qu Y, Dong R, Yang L, Kang M, Zhao J. Spontaneous spinal epidural hematoma masquerading as atypical abdominal pain in a child: A case report. Medicine (Baltimore). 2020;99(33):e21762.

Shin JJ, Kuh SU, Cho YE. Surgical management of spontaneous spinal epidural hematoma. Eur Spine J. 2006;15(6):998-1004.

Duffill J, Sparrow OC, Millar J, Can spontaneous spinal epidural haematoma be managed safely without operation? a report of four cases. J NeurolNeurosurg Psychiatry. 2000;69:816-9.

Iwatsuki K, Deguchi M, Hirata H, Kanamono T. Spontaneously Resolved Recurrent Cervical Epidural Hematoma in a 37-Week Primigravida. Global Spine J. 2015;5(5):44-7.

Rajz G, Cohen JE, Harnof S, Knoller N, Goren O, Shoshan Y et al. Spontaneous spinal epidural hematoma: the importance of preoperative neurological status and rapid intervention. J Clin Neurosci. 2015;22(1):123-8.