Spontaneous spinal epidural hematoma during pregnancy is a quite rare event requiring emergent decompressive surgery in the majority of cases to prevent permanent neurological damage. Therefore, there is little data in the literature regarding anesthetic management of cervical localization during pregnancy. The potential for difficult airway management with the patient under general anesthesia is one of the major concerns that needs to be addressed to prevent further cord compression. Anesthetic management should also include measures to maintain the mean arterial pressure to improve spinal cord perfusion. Furthermore, spine surgery in pregnant patients needs special consideration in terms of positioning and in the postoperative period.
We present a case of a 35-year-old white woman at 21 weeks of gestation with a spontaneous cervical epidural hematoma. Fiberoptic bronchoscope-guided nasal intubation was a safe option to ensure a higher rate of successful endotracheal intubation while minimizing the risk of aggravating the injury. Her care posed other multiples challenges that required a multidisciplinary team approach.
The case of our patient serves as a reminder of this rare condition and its implications regarding anesthesia.
Mahieu X, Kridelka F, Pintiaux A, Hans P, Brichant JF. Spontaneous cervical extradural hematoma in a pregnant woman. J Gynecol Obstet Biol Reprod (Paris). 1994;23:99–102.
Singh DP, Lamtha SC, Kumar S. Spontaneous spinal haematoma during pregnancy. J Assoc Physicians India. 2009;57:540–2. PubMed
Yonekawa Y, Mehdorn HM, Nishikawa M. Spontaneous spinal epidural hematoma during pregnancy. Surg Neurol. 1975;3:327–8. PubMed
Carroll SG, Malhotra R, Eustace D, Sharr M, Morcos S. Spontaneous spinal extradural hematoma during pregnancy. J Matern Fetal Med. 1997;6:218–9. PubMed
Fukui M, Swarnkar A, Williams R. Acute spontaneous spinal epidural hematomas. AJNR Am J Neuroradiol. 1999;20:1365–72. PubMed
Groen R, van Alphen A. Operative treatment of spontaneous spinal epidural hematoma: a study of the factors determining postoperative outcome. Neurosurgery. 1996;39:494–502. PubMed
Dam-Hieu P, Mihalescu M, Tadié M. Spontaneous regression of paraplegia caused by spontaneous cervico-thoracic epidural hematoma [in French]. Neurochirurgie. 2001;47:442–4. PubMed
Ohayon L, Gorhan C, Soto-Ares G, Reyns N, Pruvo JP. Acute spinal epidural and subdural hematomas. J Radiol. 2003;84:50–3. PubMed
Hentschel SJ, Woolfenden AR, Fairholm DJ. Resolution of spontaneous spinal epidural hematoma without surgery: report of two cases. Spine. 2001;26:525–7. CrossRef
Lennarson PJ, Smith DW, Sawin PD, Todd MM, Sato Y, Traynelis VC. Cervical spinal motion during intubation: efficacy of stabilization maneuvers in the setting of complete segmental instability. J Neurosurg. 2001;94(2 Suppl):265–70. PubMed
Vale FL, Burns J, Jackson AB, Hadley MN. Combined medical and surgical treatment after acute spinal cord injury: results of a prospective pilot study to assess the merits of aggressive medical resuscitation and blood pressure management. J Neurosurg. 1997;87:239–46.
Braveman FR, Scavone BM, Wong CA, Santos AC. Obstetrical anesthesia. In: Barash PG, Cullen BF, Stoelting RK, Cahalan M, Stock MC, editors. Clinical anesthesia. 6th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2009. p. 1137–67.
Binnert D, Thierry A, Michiels R, Soichot P, Perrin M. Presentation of a new case of spontaneous spinal extradural hematoma observed during labor [in French]. J Med Lyon. 1971;52:1307–9. PubMed
Matsubara S, Inoue H, Takamura K, Kimura A, Okuno S, Fujita A et al. Spontaneous spinal epidural hematoma at the 16th week of a twin pregnancy. J Obstet Gynaecol Res. 2011;37:1466–9.
- Anesthetic management of spontaneous cervical epidural hematoma during pregnancy: a case report
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