Traumatic spinal epidural hematoma associated with cervical nerve root avulsion without vertebral fractures: case report

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Traumatic spinal epidural hematoma (TSEH) is a rare condition that may cause acute spinal cord compression and lead to irreversible neurological impairment. TSEH not only compresses the cord, but it can also worsen cervical nerve root avulsion. To our knowledge, only five cases of combined TSEH and cervical nerve root avulsion have been reported in the literature. We present the case of a 42-year-old woman who suffered a motorcycle accident. On admission, she presented with mild traumatic brain injury and cervical spine and right shoulder trauma. A physical examination revealed numbness and flaccid paresis in her right arm, compromising the C5 to T1 dermatomes and myotomes. MRI images showed evidence of a right anterolateral spinal epidural hematoma (SEH) that extended from the C2 to C7 vertebral levels. MRI and electromyography findings of the presence of a pseudomeningocele from the C4-C5 to C7-T1 levels indicating brachial plexus neurotmesis supported the presence of a cervical nerve root avulsion associated with TSEH. Cervical plexus syndrome requires a comprehensive diagnostic workup. SEH should be considered a cause of nerve root avulsion and brachial plexus syndrome. We believe that the extension of SEH into the intervertebral foramina could be a radiological sign related to nerve root avulsion.

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