• Giuseppe Caruso, Marcelo Galarza, Ignazio Borghesi, Eugenio Pozzati, and Mario Vitale.
• Division of Neurosurgery, Villa Maria Cecilia Hospital, Cotignola, Italy.
• Neurosurgery. 2007 Mar 1; 60 (3): E575-6; discussion E576.

ObjectiveSpinal extramedullary hematomas stemming from cavernous angiomas in the epidural compartment are rare. It is more common for spinal epidural cavernous angiomas to present with slow and progressive myelopathy or radiculopathy. They seldom present with clinical evidence of acute spinal cord or nerve root compression.Clinical PresentationThree consecutive cases of acute spinal cavernous angiomas with overt neurological deficits were presented. These presentations included acute onset of neck pain and tetraparesis, bilateral lower extremity pain and paraparesis, and acute sciatic pain with plantar flexor weakness. The lesions were located in the cervical, thoracic, and sacral spine, respectively. The cases included either abrupt lesion enlargement secondary to a pure intralesional hemorrhage or a cavernous hemorrhage that invaded the epidural space.InterventionAll patients were treated with either laminotomy or complete resection of the hematoma and cavernoma within 12 hours after admission.ConclusionSpontaneous spinal epidural hematomas presented with significant pain and acute spinal cord and nerve root compression may represent the manifestation of a cavernous angioma. Appropriate interpretation of preoperative imaging studies may prevent delay in proper management, especially for patients in whom nerve root deficit is the only clinical expression.

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