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Phantom Epidural Hematoma
Abstract Number: SUN-54
Abstract Type: Case Report/Case Series
INTRODUCTION: Epidural hematoma (EH) is a rare but potentially catastrophic complication following neuraxial block. Spinal Epidural Lipomatosis (SEL) is also uncommon, and presenting symptoms can be like an EH. We present a case with presumed EH that was later determined to be epidural lipomatosis.
CASE: A 19-year-old G3P3003 post-partum female with obesity (BMI 33) presented with complaints of new-onset urinary incontinence and severe back pain. 2-3 days prior to the onset of symptoms she had a spontaneous vaginal delivery at an outside hospital during which she experienced 3 unsuccessful attempts to place an epidural catheter for labor analgesia. CT and MRI of her lumbar spine showed a diffuse posterior EH resulting in central canal stenosis, severe in the lower lumbar spine. Neurosurgery agreed and performed a decompressive L3/L4 laminectomy. Upon surgical exposure, the surgeons noted no epidural hematoma but rather profuse lipomatosis. The area was debulked, and the site closed. The patient’s symptoms improved by post-operative day 3, and on continued follow up there was complete resolution of symptoms.
DISCUSSION: SEL is a rare condition characterized by excessive fat deposition in the spinal canal, which can be asymptomatic or result in significant spinal cord or nerve root compression. It is most often seen in men with exogenous steroid use, while also seen in individuals with elevated endogenous steroids (e.g., Cushing disease)(1). Many idiopathic cases have also been reported, and 70% of all cases are in obese patients(2). Clinical presentation may consist of pain, progressive paresthesia, or weakness in the lower extremities; however, acute neurological symptoms are uncommon(1). In a literature review conducted by D. Al-Khawaja et.al., surgical intervention was sought in 90% of all cases, with 60% of those presenting with lumbar disease involvement experiencing a full recovery(2). Our patient had never used exogenous steroids and had no signs or symptoms of overt endocrinopathy. Additionally, her clinical picture was clouded by the acute onset of her symptoms in addition to the recent neuraxial attempts.
1. López-González A, Resurrección Giner M. Idiopathic spinal epidural lipomatosis: urgent decompression in an atypical case. European Spine Journal. 2008;17S2:225-227.
2. Darweesh Al-Khawaja, K. Seex, G. D. Eslick. Spinal epidural lipomatosis-a brief review. Journal of Clinical Neuroscience, vol. 15, no. 12, pp. 1323–1326, 2008.