Spontaneous Spinal Epidural Haematoma at C 5-Th 7 Level after Spontaneous Delivery

Abstract

We describe a patient with sudden onset (29 hours postpartum) pain originating at C-Th level of the spinal cord followed by impaired movement of all limbs. An urgent MRI of the cervical and thoracic spine was performed and showed an extensive epidural haematoma at level C5-Th7 localised dorsally from the spinal cord and inducing its compression, which was treated via hemilaminectomy and evacuation of haematoma. A subsequent MRI showed evidence of the development of myelopathy probably ischaemic in aetiology at level C6–C7 measuring approximately 7 × 3 × 17 mm. Neurologic investigation disclosed spastic paraparesis mainly in the lower limbs. The neurological deficit was improved by a six month intensive rehabilitation program. The prognosis of such a severe complication is always dependent upon the localisation of the haematoma and time between onset of the haematoma and spinal cord decompression.