| Vol. 5, Issue 1 |
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Chhabra A. et al |
Spinal Epidural Space:
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Traumatic Lesions Epidural hemorrhage (EDH) can result from minor or major trauma (Fig- 10a,b), anticoagulation (Fig- 10c), coagulopathy, transient venous hypertension, disk herniation, vascular anomalies, pregnancy, paget’s disease or may be idiopathic. Heterogeneous hyperintensity to spinal cord on T1W images with focal hypointensity or mixed signal on T2-weighted images should suggest the diagnosis of acute spinal EDH. Differentiation between epi- and subdural hematomas may require transverse T2*-weighted gradient echo sequences. On post contrast images, no significant enhancement is noted. Some peripheral enhancement from dural hyperemia or linear enhancement in epidural septations or vessels may be seen. Associated cord compression, Vertebral fractures or retropulsion may be seen (Fig- 11a,b). Severity of neurologic impairment has the greatest impact on management and outcome. Nonoperative treatment may be successful in cases with minimal neurologic deficits, despite cord compression revealed by MR imaging. Differentiation from the extruded disc is possible utilizing the following criteria- high signal on T1-weighted images, teardrop shaped mass in the sagital plane, size greater than half the vertebral body height in a craniocaudal dimension, plasticity (the mass is seen to conform closely to the contours of bone) and little or no disk space narrowing unless associated with disc herniation.10,11 A Pseudomeningocele may also result from trauma or operative intervention due to dural tear (Fig- 12a,b). These are most common in cervical and lumbar spine and are seen as localized CSF. |  |
| Fig. 10-ab. Axial and coronal T2W scans in a 21 yr old man in a MVA demonstrate a posterior epidural hematoma at C4 level. Also note the hyperintensity in the posterior paraspinal soft tissue planes consistent with a recent injury. |
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| Fig. 10-c. Sagital T2W scan in a 55 yr old man on coumadin showing spontaneous non-traumatic posterior epidural hematoma. (Courtesy: Jack Greenberg, MD) |
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| Fig. 11-ab. Sagital T1W, T2W spin echo and axial T2W GRE scans in a 20 year old woman in a MVA demonstrate acute subluxation of C6 over C7 vertebra with partial cord transection and posterior paraspinal hematoma.Also note the anterior epidural hematoma (yellow arrow) and hemorrhagic cord infarcts (red arrow). | |
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| Fig. 12-ab. Axial T1W and T2W scans in a 71 year old woman demonstrate a post-laminectomy dural tear and a posterior pseudomeningoclele with extension into the subcutaneous tissue planes. |
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