Neurosurg Focus
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Spinal epidural hematoma (SEH) is an uncommon cause of acute cauda equina syndrome. Most of these hematomas are caused by trauma, anticoagulation therapy, and vascular anomalies or occur following spinal epidural procedures and, rarely, spinal surgery. Spontaneous SEH is an extremely rare occurrence. ⋯ Clinical evaluation is the most important tool in the early diagnosis of SEH. Once the disease is suspected clinically and confirmed on diagnostic imaging, emergency evacuation of the lesion should be performed. Prognosis depends on the rate of development of symptoms, interval to surgery, level of spinal involvement, and degree of neurological deficit.
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Symptoms of cauda equina syndrome (CES) can include low-back pain, sciatica, lower-extremity weakness, sensory deficit, perineal hypesthesia or anesthesia, and loss of bowel or bladder function. Several causes of the syndrome are recognized, but its optimal treatment remains controversial and has been broadly based on data gathered from series involving herniated discs. Information on the treatment of CES caused by low lumbar traumatic injuries has not been well documented. ⋯ Based on the evidence in this study, the severity of a patient's condition on initial presentation is the most crucial factor in predicting outcome following CES due to low lumbar injuries. Although the matter of the timing of surgery remains controversial, the authors of this study recommend that surgery be performed within 48 hours of syndrome onset.