Chronic extradural spinal hematoma after previous trauma

Spinal chronic extradural hematomas are extremely rare and ecome clinically relevant when they affect the spinal cord nd/or nerve roots causing neurological symptoms [1,2]. A 53ear-old male presented to our hospital with a 9-month history of ain following an accidental trauma (sudden fall from a chair). e experienced a gradual onset of low back pain and also comlained of mild neurogenic claudication. Nevertheless he was reated with anti-inflammatory medications and physical therpy; the symptoms gradually worsened and at the moment of dmission in our hospital he showed relevant claudication and isestesias. Physical exam revealed a normal lumbar range of otion and the absence of muscolotendinous reflexes in the ower limbs without motor deficit or sphincter disturbance. An RI of the dorsal and lumbar spine was performed and revealed round mass in the vertebral canal at L1 level (Fig. 1). The ass showed hypointense signal on T2 weighted image and tir sequences (hemosiderin deposition) (Figs. 2 and 3), with o enhancement on gadolinium administration (Fig. 4) and with o actual bleeding on gradient-echo sequences and it did not isrupt the longitudinal posterior ligament (Fig. 5). Because of he clinical and radiological findings, a surgical procedure was erformed. Operation neurosurgeons performed partial laminecomy of L1 and removed the extradural hematoma (Fig. 6). The atient was discharged after few days without relevant neuroogical problems but for a brief period he was admitted to a ehabilitation center. Histopathological examination revealed a hronic hematoma and the bacterial culture showed no sign of nfection. Epidural spinal hematomas depend on a variety of sitations and can be divided into two types: acute and chronic. hronic SEHs are rarer than acute SEHs. The former ones re common in spinal surgery but rarely produce neurological eficits [3]. The chronic hematomas, on the other hand produce ome neurological symptoms (parestesie, claudication, etc.). For his reason even if rare spinal extradural chronic hematoma has o be considered in the differential diagnosis of nerve roots pain 4,5,7]. It is important to collect data from patient history (i.e. revious trauma) and to perform a clinical evaluation and then n MR spinal exam. The common site of a spontaneous chronic ematoma in the few articles reported in the literature is the horacolumbar region [1,2,4,5,8]. Hematoma seems to originate F