Sudden onset paraplegia

Clinical introduction

A 75-year-old man presented with acute onset thoracic back pain, progressive leg weakness with numbness and urinary retention. His symptoms started suddenly and progressed overnight. He denied a recent history of trauma. On neurological examination he had complete loss of all sensations below Th10 level and leg paraplegia (American Spinal Injury Association grade A myelitis). Admission lateral spine X-ray and non-contrast CT were performed (figures 1 and 2).

Question

What is the most likely cause of the clinical presentation?

Fracture of Th12 vertebral body

Acute cerebrovascular accident

Intramedullary tumour

Acute spontaneous spinal haematoma

Answer:D

Acute spontaneous spinal epidural haematoma (ASSEDH). The patient's X-rays and CT showed a compression fracture at Th12, but the neurological examination was consistent with a lesion at the Th10 neurological level. Moreover, the fracture was likely old due to the finding of endplate and cortical osteosclerosis and remodelling...

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