Urinary Retention without Tetraparesis as a Sequel to Spontaneous Spinal Epidural Hematoma

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A 55-year-old man suddenly developed neck pain, tetraplegia and decreased sensation below the neck. He was diagnosed with SSEH. Surgical removal of the hematoma, and laminoplasty were performed. At 2 months after the onset of the disease, the patient regained the ability to walk. However, at 5 months after the onset of the disease, the patient remained in a state of urinary retention even though his neurological findings were normal, except for mildly brisk reflexes in the lower extremities and decreased superficial sensation below the level of T4 including the perineal area. A urodynamic study showed normal bladder sensation, despite an acontractile detrusor and an unrelaxing external sphincter upon voiding. It is postulated that the descending micturition pathways (just inside the pyramidal tracts) were selectively affected, while the ascending micturition pathways (the dorsal columns) were preserved in the present case.