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Spinal subdural and epidural hematoma
Medical expert of the article
Last reviewed: 08.07.2025
A spinal subdural or epidural hematoma is a collection of blood in the subdural or epidural space that can cause compression of the spinal cord.
Spinal subdural or epidural hematoma (usually in the thoracic or lumbar region) is uncommon but may develop after back trauma, anticoagulant or thrombolytic therapy, or in patients with hemorrhagic diathesis, after lumbar puncture. Symptoms begin with local or radicular pain and percussion tenderness, which are usually severe. Spinal cord compression may develop; compression in the lumbar spinal canal may cause compression of the cauda equina roots and paresis of the lower extremities. Neurological deficit progresses over minutes to hours.
Spinal subdural or epidural hematoma may be suspected in patients with acute nontraumatic spinal cord compression or acute unexplained lower limb paresis, especially in the presence of possible causes (eg, trauma, hemorrhagic diathesis). Diagnosis is MRI, but if MRI is not possible, myelography plus CT is performed. Treatment is urgent surgical drainage. Patients receiving coumarins (warfarin) should receive vitamin K 2.5-10 mg subcutaneously and fresh frozen plasma if necessary until the INR is normalized. Platelet transfusions are indicated for patients with thrombocytopenia.
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