Acute paraplegia caused by a spontaneous extradural heamatoma of the conus medullaris area.

Four patients with a typical clinical picture of spinal extradural heamatoma of the conus area are presented. Initial symptoms were acute low back pains. The development of symmetrical paraparesis took place in a matter of hours, and spread to total paraplegia. The sensory level was as high as the groins and bladder and rectum paralysis developed early. All patients were over 63, mean age 67 years. Two patients had coagulation defects, one was on anticoagulants, and the other had a severe thrombocytosis. Two patients had used salicylates for rheumatic pains; in one of those patients there was a hemangioma on PAD . In 2 patients, the neuroradiological diagnosis was confirmed with rhizography (Figs. 1 and 2); in the third patient the rhizography was misleading but in her and in a fourth patient the oxygen-myelography was diagnostic, showing an extradural compression in the conus area. Haematomas were removed in all patients through an extensive decompressive laminectomy within 24 hours from the onset of the symptoms. Recovery was good in 2 cases, and fair in one patient who had a poor recovery of the bladder function. In on patient, both paraplegia and bladder paralysis were permanent after 3 years. The differential diagnosis by myelography between the cauda equina syndrome caused by typical disc compression from the one side and from vascular medullary syndromes and myelitis from the other side should be clear. For good functional recovery, early myelography and operative decompression are imperative.