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Chapter 63. Diagnosis and Management of Spinal and Peripheral Nerve Hematoma

Spinal epidural hematoma:

A. Is an accumulation of blood between the dura and the arachnoid of the spinal canal

B. Is always spontaneous

C. Incidence is decreasing

D. Is typically asymptomatic

D is correct. Spinal epidural hematoma is typically asymptomatic.

A is incorrect. An accumulation of blood between the dura and the arachnoid is a spinal subdural hematoma. A spinal epidural hematoma is defined as an accumulation of blood between the vertebrae and the dura of the spinal canal.

B is incorrect. Spontaneous spinal epidural hematoma can occur, but it is a rare condition with an estimated incidence of 0.1 patients per 100,000 patients per year.1 Spinal epidural hematoma can also be caused by invasive procedures in or near the epidural space or by a traumatic injury.

C is incorrect. Previously, the reported incidence of spinal epidural hematoma was less than 1:150,000 for epidural and less than 1:220,000 for spinal anesthesia.2 However, newer studies show higher incidences of spinal epidural hematoma after neuraxial anesthesia. In elderly, female patients undergoing total knee arthroplasty an incidence of 1:3600 has been reported.3,4

Which of the following statements is correct regarding the risks factors of spinal epidural hematoma?

A. Anticoagulation therapy is a risk factor.

B. Female gender is not a risk factor.

C. Increasing age is not a risk factor.

D. Race is a risk factor.

A is correct. Anticoagulation therapy is a risk factor.

B is incorrect. Female gender is a risk factor. An explanation could be the higher prevalence of osteoporosis in females. Osteoporosis causes narrowing of the epidural space, thereby increasing the risk of a spinal epidural hematoma.3-5

C is incorrect. With increasing age the epidural space becomes narrower and less compliant. Osteoporosis may account for the association to both female gender and increasing age.3-5

D is incorrect. Race is not a known risk factor of spinal epidural hematoma.

Which of the following statements is true regarding diagnosing spinal epidural hematoma?

A. Acute axial back pain is a typical presenting symptom.

B. A complete blood cell count is relevant to diagnose spinal epidural hematoma.

C. CT myelography is ...

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