1
|
Ali F, Arshad K, Latif R, Farooq A, Nanjundappa A. Spontaneous spinal epidural hematoma following IV heparin and catheter-directed thrombolysis for deep vein thrombosis. J Vasc Surg Cases Innov Tech 2024; 10:101541. [PMID: 38994220 PMCID: PMC11238116 DOI: 10.1016/j.jvscit.2024.101541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/10/2024] [Indexed: 07/13/2024] Open
Abstract
Spontaneous spinal epidural hematoma (SSEH) is a rare condition, and it usually presents with acute onset neck or back pain, progressive weakness, and other symptoms of spinal cord compression. Catheter-directed thrombolysis is one option for limbs threatened by iliofemoral venous thrombosis; other options, such as venous thrombectomy (either open or percutaneous), are also available. There are few reported cases of SSEH owing to catheter-directed thrombolysis for deep venous thrombosis (DVT). We present a case of a 65-year-old man who presented with left lower limb extensive iliofemoral DVT and received catheter-directed thrombolysis. The patient initially had rapid improvement in his symptoms with restoration of limb perfusion. However, within 6 hours of starting catheter-directed thrombolysis, the patient developed extensive SSEH and underwent emergent spinal decompression surgery with laminectomy of T11 to T12 with complete resolution of the neurological deficit. Clinicians should consider SSEH in differential diagnosis if the patient develops acute onset neck or back pain after catheter-guided thrombolysis for DVT.
Collapse
Affiliation(s)
- Farman Ali
- Internal Medicine, Corewell Health Dearborn Hospital, Dearborn, MI
| | - Khurram Arshad
- Internal Medicine, Corewell Health Dearborn Hospital, Dearborn, MI
| | - Rabia Latif
- Internal Medicine, Mclaren Flint Hospital, Flint, MI
| | - Ali Farooq
- Internal Medicine, Charleston Area Medical Center, Charleston, SC
| | | |
Collapse
|
2
|
Vastani A, Baig Mirza A, Khoja AK, Bartram J, Shaheen S, Rajkumar S, China M, Lavrador JP, Bleil C, Bell D, Thomas N, Malik I, Grahovac G. Prognostic factors and surgical outcomes of spontaneous spinal epidural haematoma: a systematic review and meta-analysis. Neurosurg Rev 2022; 46:21. [PMID: 36538111 DOI: 10.1007/s10143-022-01914-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
Spontaneous spinal epidural haematoma (SSEH) is a rare disease defined as blood accumulation within the vertebral epidural space without a cause identified, which can lead to severe neurological deficits. We aim to provide a comprehensive understanding of the prognostic factors affecting surgical outcomes in true SSEH and propose a critical time frame for operative management. A systematic literature search was performed and registered, using OVID Medline and EMBASE, in line with the PRISMA guidelines. Relevant demographic, clinical, surgical, and outcome data were extracted. The ASIA scale was uniformly used throughout our systematic review. Statistical analysis was performed via logistic regression. Of the 1179 articles examined, we included 181 studies involving 295 adult patients surgically treated for SSEH. SSEH were most commonly found in the cervicothoracic spine, with 2-4 spinal segments most commonly involved. Multivariable logistic regression model showed that the following factors were statistically significant in the post-operative outcome: operation type (P = 0.024), pre-operative neurologic status (P < 0.001), use of warfarin (P = 0.039), and operative interval (P = 0.006). Our retrospective analysis confirms the reversibility of severe neurological deficits after surgical intervention, with a prognosis of post-operative outcomes determined by the use of warfarin, pre-operative ASIA grade, and above all surgical evacuation within 12 h.
Collapse
Affiliation(s)
- Amisha Vastani
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK.
| | - Asfand Baig Mirza
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Abbas Khizar Khoja
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - James Bartram
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Safwan Shaheen
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Shivani Rajkumar
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Musa China
- Division of Medicine, University College London (UCL), London, UK
| | - Jose Pedro Lavrador
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Cristina Bleil
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - David Bell
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Nick Thomas
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Irfan Malik
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Gordan Grahovac
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| |
Collapse
|
3
|
Xu Q, Wang Y, Wang D, Xu B, Yu Z, Yin X, Lang D. Spontaneous Spinal Subdural Hematoma after Percutaneous Mechanical Thrombectomy Combined with Catheter-Directed Thrombolysis for Deep Venous Thrombosis: A Case Report. Ann Vasc Surg 2020; 66:670.e1-670.e4. [PMID: 31978482 DOI: 10.1016/j.avsg.2020.01.078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/23/2019] [Accepted: 01/02/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Percutaneous mechanical thrombectomy combined with catheter-directed thrombolysis is one of the most important methods for deep venous thrombosis treatment. Spontaneous spinal subdural hematoma is a remarkably rare complication in the thrombolysis process with catastrophic consequences, as shown in this case report. METHODS Percutaneous mechanical thrombectomy, percutaneous angioplasty, and catheter-directed thrombolysis were performed for the patient. Postoperatively, the patient was diagnosed with spontaneous spinal subdural hematoma and received a series of medical treatments and surgical interventions. RESULTS The patient was still paraplegic and incontinent at the postoperative 7-month follow-up. CONCLUSIONS Neurologic symptoms must be monitored carefully both during and after the thrombolysis procedure. The onset of spinal neurologic deficits in any patient must raise the suspicion that a spinal subdural hematoma has occurred. Surgical decompression beyond 24 hr may cause permanent neurological damage.
Collapse
Affiliation(s)
- Qiyang Xu
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No.2 Hospital), Ningbo, Zhejiang, China
| | - Yi Wang
- Department of Radiotherapy and chemotherapy, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No.2 Hospital), Ningbo, Zhejiang, China
| | - Di Wang
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No.2 Hospital), Ningbo, Zhejiang, China
| | - Bin Xu
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No.2 Hospital), Ningbo, Zhejiang, China
| | - Zuanbiao Yu
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No.2 Hospital), Ningbo, Zhejiang, China
| | - Xiaoliang Yin
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No.2 Hospital), Ningbo, Zhejiang, China
| | - Dehai Lang
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No.2 Hospital), Ningbo, Zhejiang, China.
| |
Collapse
|
4
|
Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy. Reg Anesth Pain Med 2018; 43:263-309. [DOI: 10.1097/aap.0000000000000763] [Citation(s) in RCA: 442] [Impact Index Per Article: 73.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
5
|
Kitamura Y, Onozuka S, Ichimura S, Yoshida K. Spontaneous spinal epidural hematoma (SSEH) after coil embolization of cerebral aneurysm: implication of high SSEH frequency in East Asia. Clin Neurol Neurosurg 2012; 115:649-50. [PMID: 22795549 DOI: 10.1016/j.clineuro.2012.06.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 06/11/2012] [Accepted: 06/24/2012] [Indexed: 11/26/2022]
|
6
|
Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition). Reg Anesth Pain Med 2010; 35:64-101. [PMID: 20052816 DOI: 10.1097/aap.0b013e3181c15c70] [Citation(s) in RCA: 659] [Impact Index Per Article: 47.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The actual incidence of neurologic dysfunction resulting from hemorrhagic complications associated with neuraxial blockade is unknown. Although the incidence cited in the literature is estimated to be less than 1 in 150,000 epidural and less than 1 in 220,000 spinal anesthetics, recent epidemiologic surveys suggest that the frequency is increasing and may be as high as 1 in 3000 in some patient populations.Overall, the risk of clinically significant bleeding increase with age,associated abnormalities of the spinal cord or vertebral column, the presence of an underlying coagulopathy, difficulty during needle placement,and an indwelling neuraxial catheter during sustained anticoagulation( particularly with standard heparin or low-molecular weight heparin). The need for prompt diagnosis and intervention to optimize neurologic outcome is also consistently reported. In response to these patient safety issues, the American Society of Regional Anesthesia and Pain Medicine (ASRA) convened its Third Consensus Conference on Regional Anesthesia and Anticoagulation. Practice guidelines or recommendations summarize evidence-based reviews. However, the rarity of spinal hematoma defies a prospective randomized study, and there is no current laboratory model. As a result,the ASRA consensus statements represent the collective experience of recognized experts in the field of neuraxial anesthesia and anticoagulation. These are based on case reports, clinical series, pharmacology,hematology, and risk factors for surgical bleeding. An understanding of the complexity of this issue is essential to patient management.
Collapse
|
7
|
Vertebral artery dissection as an extremely rare cause of spinal epidural hematoma: case report and review of the literature. Acta Neurochir (Wien) 2009; 151:1319-23. [PMID: 19247570 DOI: 10.1007/s00701-009-0223-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Accepted: 02/12/2009] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To present a patient with a cervico-thoracic ventrally located epidural hematoma caused by dissection and subsequent bleeding of the cervical portion of the vertebral artery. SUMMARY AND BACKGROUND DATA Non traumatic epidural hematoma is a rare entity. The etiology usually is not clarified: a venous origin is usually suspected although an arterial source is also possible. CLINICAL REPORT A 32-year-old woman presented with a ventrally located cervico-thoracic epidural hematoma caused by non traumatic dissection and dissecting aneurysm rupture of the cervical portion of the vertebral artery. The dissection was demonstrated by magnetic resonance imaging and digital subtraction angiography. The patient had no neurological symptoms and was treated by conservative methods. Follow up imaging showed healing of the vertebral artery and resorption of the epidural hematoma. CONCLUSION Dissection of the cervical portion of the vertebral artery with subsequent perivascular bleeding is not well recognized as a possible cause of a spinal epidural hematoma. Even though this entity and the underlying cause may be rare, we suggest a vigilant search for vertebral artery injury in cases of ventrally located cervical and upper thoracic epidural hematoma.
Collapse
|
8
|
Abstract
Venous thromboembolism is a life-threatening adverse event in spine patients and presents difficult decisions for the surgeon and patient. Prophylactic protocols have been established to prevent the occurrence of venous thromboembolism and its sequelae, including venous occlusion, edema, postthrombotic syndrome, and death. Despite the known benefits of prophylaxis, some surgeons choose not to use it because of concerns over increased bleeding complications and possible iatrogenic neurologic injury. Although mechanical prophylaxis remains an important element in venous thromboembolism prevention, low-molecular-weight heparin is better than other pharmacologic therapies in decreasing the incidence of major events.
Collapse
|
9
|
Komvilaisak P, Grant R, Weitzman S, Brandao L, Blaser S, Chait P, Connolly B, Williams S. Epidural hematoma following tissue plasminogen activator (tPA) therapy for pulmonary embolism in a pediatric patient with stage IV Burkitt's lymphoma: A case report. Thromb Res 2008; 121:709-12. [PMID: 17854866 DOI: 10.1016/j.thromres.2007.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Revised: 08/08/2007] [Accepted: 08/08/2007] [Indexed: 11/21/2022]
|