7 EMH is a common manifestation of chronic hemolytic anemias, particularly severe thalassemia, and can involve various organs of the body including liver, spleen, lymph nodes, adrenal gland and thoracic paravertebral regions. It is a compensatory mechanism to cope with long standing anemia. The clinical features secondary to EMH are variable and depend on the site of formation of the hematopoietic tissues. Spinal cord compression as a consequence of EMH in the intraspinal epidural space, is a rare complication in thalassemic patients. 3,5 The management of spinal cord compression due to EMH remains controversial.
Surgical management is suggested in severe cases refractory to radiotherapy and blood transfusion.
However, radiotherapy alone is gradually emerging as the treatment of choice. 1,4,8,9,13 Clinical awareness is important in the diagnosis but documentation by an imaging technique is indispensable. 11 CT myelography is also a good modality for detection of epidural pressure effect. Tc colloid marrow scan. In summary, EMH while a rare cause of epidural pressure effect and paralysis, may be encountered among the patients with beta-thalassemia in endemic areas.