1
|
Emergency surgical decompression for spontaneous spinal epidural hematoma in octogenarians: risk factors, clinical outcomes, and complications. Acta Neurochir (Wien) 2022; 165:905-913. [PMID: 36571626 PMCID: PMC10068654 DOI: 10.1007/s00701-022-05457-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/10/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE Spontaneous spinal epidural hematoma (SSEH) is a rare but disabling disease. Although several cases have been reported in the literature, their treatment remains unclear, especially in patients with advanced age. We, therefore, aimed to describe the clinical outcomes of cervical SSEH in octogenarians with an acute onset of neurological illness undergoing laminectomy. METHODS Electronic medical records from a single institution between September 2005 and December 2020 were retrieved. Data on patient demographics, neurological conditions, functional status, surgical characteristics, complications, hospital course, and 90-day mortality were also collected. RESULTS Twenty-two patients aged ≥ 80 years with SSEH undergoing laminectomy were enrolled in this study. The mean Charlson comorbidity index was 9.1 ± 2.0, indicating a poor baseline reserve. Ten individuals (45.5%) were taking anticoagulant agents with a pathologic partial thromboplastin time (PTT) of 46.5 ± 3.4 s. Progressive neurological decline, as defined by the motor score (MS), was observed on admission (63.8 ± 14.0). The in-hospital and 90-day mortality were 4.5% and 9.1%, respectively. Notably, the MS (93.6 ± 8.3) improved significantly after surgery (p < 0.05). Revision surgery was necessary in 5 cases due to recurrent hematoma. Anticoagulant agents and pathological PTT are significant risk factors for its occurrence. Motor weakness and comorbidities were unique risk factors for loss of ambulation. CONCLUSIONS Laminectomy and evacuation of the hematoma in octogenarians with progressive neurological decline induce clinical benefits. Emergent surgery seems to be the "state of the art" treatment for SSEH. However, potential complications associated with adverse prognostic factors, such as the use of anticoagulants, should be considered.
Collapse
|
2
|
İŞTEMEN İ, AVCİ A. Spontaneous Spinal Epidural Haematoma Mimicking a Heart Attack: A Case Report. JOURNAL OF EMERGENCY MEDICINE CASE REPORTS 2022. [DOI: 10.33706/jemcr.1051335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
3
|
A retrospective analysis of 30 patients with spontaneous spinal epidural hematoma. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
4
|
Fiani B, Jarrah R, Fiani NJ, Runnels J. Spontaneous cervical epidural hematoma: Insight into this occurrence with case examples. Surg Neurol Int 2021; 12:79. [PMID: 33767883 PMCID: PMC7982115 DOI: 10.25259/sni_15_2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/10/2021] [Indexed: 01/30/2023] Open
Abstract
Background: First characterized in the 19th century, spontaneous spinal epidural hematoma (SSEH) is known as the idiopathic accumulation of blood within the spinal canal’s epidural space, causing symptoms varying from general back pain to complete paraplegia. With varying etiologies, a broad spectrum of severity and symptoms, a time-dependent resolution period, and no documented diagnosis or treatment algorithm, SSEH is a commonly misunderstood condition associated with increasing morbidity. While SSEH can occur at any vertebrae level, 16% of all SSEH cases occur in the cervical spine, making it a region of interest to clinicians. Case Description: Herein, the authors present two case examples describing the clinical presentation of SSEH, while also reviewing the literature to provide a comprehensive overview of its presentation, pathology, and treatment. The first case is a patient with nontraumatic sudden onset neck pain with rapidly progressing weakness. The second case is a patient with painless weakness that developed while taking 325 mg of aspirin daily. Conclusion: Clinicians should keep SSEH in their differential diagnosis when seeing patients with nontraumatic sources of weakness in their extremities. The appropriate steps should be followed to diagnose and treat this condition with magnetic resonance imaging and surgical decompression if there are progressive neurological deficits. There is a continued need for more extensive database-driven studies to understand better SSEHs clinical presentation, etiology, and ultimate treatment.
Collapse
Affiliation(s)
- Brian Fiani
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California, United States
| | - Ryan Jarrah
- College of Literature, Arts, and Sciences, University of Michigan, Flint, Michigan, United States
| | - Nicholas J Fiani
- Medical School, University of Medicine and Health Sciences, New York, United States
| | - Juliana Runnels
- School of Medicine, University of New Mexico, Albuquerque, New Mexico, United States
| |
Collapse
|
5
|
Musha Y, Kinjo S, Ishimine Y, Takesue Y, Sakamoto T, Ito K. Therapeutic strategy for acute spinal cord paralysis by epidural hematoma derived from the application of non-operative observation and the optimal timing to convert to surgical intervention. J Clin Neurosci 2021; 86:242-246. [PMID: 33775335 DOI: 10.1016/j.jocn.2021.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/30/2020] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Abstract
Some cases of acute spinal cord paralysis by epidural hematoma have made complete recovery through natural progression. This group cannot be ignored in choosing a therapy. We have considered the applications of non-operative observation and the optimal timing to convert to surgical intervention. Of the 454 cases reported, cases that were of trauma/post-operative, undergone epidural block, lumbosacral level, paralysis-free, were excluded. 10 clinical items were identified as factors related to the outcome of therapy, and a total of 142 cases (73 surgical and 69 non-surgical/observation cases) which included all items in its record, were extracted for this study. 104 cases that made complete recovery from spinal paralysis (CR) includes 65 cases without surgical intervention (NOP-CR). Using "paralysis recovery start time (PRST)", ROC analysis was conducted to show the diagnostic time needed to detect the cases of CR and NOP-CR. Clinical characteristics of CR and NOP-CR were identified using multiple logistics regression analysis. CR probability were higher at PRST < 15 h from the onset and NOP-CR was even higher at < 11 h. Three clinical items: incomplete motor paralysis, no use of anti-coagulant therapy, and PRST within 15 h were found to be the characteristics of CR and NOP-CR. The case with all 3 items; especially PRST within 11 h from onset, is applicable to non-operative observation. Immediate surgical intervention at 6-hours is recommended in cases that presented with unchanged complete motor paralysis. Observation treatment is discontinued and converted to surgery if motor usefulness is not regained at 15-hours.
Collapse
Affiliation(s)
- Yoshiro Musha
- Department of Orthopaedic Surgery, Toho University Ohashi Medical Center, 2-22-36 Ohashi, Meguro-ku, Tokyo 153-8515, Japan.
| | - Sumito Kinjo
- Department of Orthopaedic Surgery, Toho University Ohashi Medical Center, 2-22-36 Ohashi, Meguro-ku, Tokyo 153-8515, Japan
| | - Youhei Ishimine
- Department of Orthopaedic Surgery, Toho University Ohashi Medical Center, 2-22-36 Ohashi, Meguro-ku, Tokyo 153-8515, Japan
| | - Yuya Takesue
- Department of Orthopaedic Surgery, Toho University Ohashi Medical Center, 2-22-36 Ohashi, Meguro-ku, Tokyo 153-8515, Japan
| | - Tetsuo Sakamoto
- Department of Orthopaedic Surgery, Toho University Ohashi Medical Center, 2-22-36 Ohashi, Meguro-ku, Tokyo 153-8515, Japan
| | - Keisuke Ito
- Department of Neurosurgery, Toho University Ohashi Medical Center, 2-22-36 Ohashi, Meguro-ku, Tokyo 153-8515, Japan
| |
Collapse
|
6
|
Wada T, Harada T, Ikeda K, Hiroshige J. Spontaneous spinal epidural haematoma due to polypharmacy including multiple antiplatelet agents. Postgrad Med J 2020; 97:487-488. [PMID: 32576642 DOI: 10.1136/postgradmedj-2020-137755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/19/2020] [Accepted: 06/01/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Takahide Wada
- Department of Neurology, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Taku Harada
- General Medicine, Showa University Koto Toyosu Hospital, Tokyo, Japan .,Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Keiichiro Ikeda
- General Medicine, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Juichi Hiroshige
- General Medicine, Showa University Koto Toyosu Hospital, Tokyo, Japan
| |
Collapse
|
7
|
Gomes PA, Cernadas E, Sá J, Brito H, Costa R. Spontaneous Spinal Haemorrhage as a Complication of Oral Anticoagulant Therapy: A Case Report and Literature Review. Eur J Case Rep Intern Med 2018; 5:000887. [PMID: 30755993 PMCID: PMC6346978 DOI: 10.12890/2018_000887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 11/09/2018] [Indexed: 01/30/2023] Open
Abstract
Spinal cord haematoma, or haematomyelia, is a rare condition caused by several unusual disease processes. Traumatic events, such as spinal cord injury and surgery or procedures involving the spinal cord, are the most important causes of spinal cord haematoma. Rarely, it is associated with anticoagulation therapy. Irrespective of cause, spinal cord haematoma is considered a neurosurgical emergency and must be treated promptly in order to prevent neurological sequelae. The authors describe the case of a 69-year-old patient taking warfarin in the therapeutic range for a mechanic mitral valve, who developed chest pain with cervical and dorsal radiation, and experienced sudden paraparesis of the limbs. A CT of the spine confirmed haematomyelia. A high index of suspicion, prompt recognition and immediate intervention are essential to prevent major morbidity and mortality from intraspinal haemorrhage. LEARNING POINTS This article reports an unusual presentation of spontaneous spinal haematoma, imposing the careful elaboration of differential diagnoses, which is very important in internal medicine.The description of this low-incidence case allows the scientific community to assist in approaching patients with similar symptoms.The lack of studies about the etiology and treatment of spontaneous spinal haematoma underlines the need for further studies and research in the area in order to increase the scientific evidence on the approach of these patients.
Collapse
Affiliation(s)
- Patrícia A Gomes
- Internal Medicine Department, Centro Hospitalar Cova da Beira, EPE, Covilhã, Portugal
| | - Eduardo Cernadas
- Internal Medicine Department, Centro Hospitalar Cova da Beira, EPE, Covilhã, Portugal
| | - Juliana Sá
- Internal Medicine Department, Centro Hospitalar Cova da Beira, EPE, Covilhã, Portugal
| | - Helena Brito
- Internal Medicine Department, Centro Hospitalar Cova da Beira, EPE, Covilhã, Portugal
| | - Ricardo Costa
- Emergency Department, Centro Hospitalar Cova da Beira, Covilhã, Portugal
| |
Collapse
|
8
|
Spontaneous Spinal Epidural Hematoma Associated With the Use of Low-dose Aspirin in Elderly Patient. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2018; 2:e059. [PMID: 30656250 PMCID: PMC6324892 DOI: 10.5435/jaaosglobal-d-18-00059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Spontaneous spinal epidural hematoma is a rare condition defined by bleeding in the epidural space of the spine with no identifiable causes such as trauma, vascular malformation, or bleeding disorders. This is a case of a 79-year-old woman with a medical history of diabetes mellitus, dyslipidemia, and hypertension presented with the sudden onset of severe thoracolumbar back pain associated with weakness and numbness in her bilateral lower limb. Examination of the lower limb showed bilateral lower limb motor and sensory deficits. Laboratory investigations showed normal results. MRI showed posterior extradural intraspinal hematoma from T11 to L3 vertebrae. Patient underwent right hemilaminectomy and posterior decompression of T12 and L1 vertebrae to evacuate the hematoma. Postoperatively, her neurologic complications improved gradually. Decision was made not to restart aspirin. On follow-up at 1 year, the patient had complete recovery of neurologic complications of both lower limb and had no recurrence of bleeding. In short, this is a case of spontaneous spinal epidural hematoma associated with long-term use of low-dose aspirin in an elderly patient requiring surgical evacuation of hematoma with good functional outcome after the surgery. Therefore, aspirin should be prescribed cautiously especially to elderly patients.
Collapse
|
9
|
Li J, Halaszynski T. Neuraxial and peripheral nerve blocks in patients taking anticoagulant or thromboprophylactic drugs: challenges and solutions. Local Reg Anesth 2015; 8:21-32. [PMID: 26347411 PMCID: PMC4531015 DOI: 10.2147/lra.s55306] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Incidence of hemorrhagic complications from neuraxial blockade is unknown, but classically cited as 1 in 150,000 epidurals and 1 in 220,000 spinals. However, recent literature and epidemiologic data suggest that for certain patient populations the frequency is higher (1 in 3,000). Due to safety concerns of bleeding risk, guidelines and recommendations have been designed to reduce patient morbidity/mortality during regional anesthesia. Data from evidence-based reviews, clinical series and case reports, collaborative experience of experts, and pharmacology used in developing consensus statements are unable to address all patient comorbidities and are not able to guarantee specific outcomes. No laboratory model identifies patients at risk, and rarity of neuraxial hematoma defies prospective randomized study so “patient-specific” factors and “surgery-related” issues should be considered to improve patient-oriented outcomes. Details of advanced age, older females, trauma patients, spinal cord and vertebral column abnormalities, organ function compromise, presence of underlying coagulopathy, traumatic or difficult needle placement, as well as indwelling catheter(s) during anticoagulation pose risks for significant bleeding. Therefore, balancing between thromboembolism, bleeding risk, and introduction of more potent antithrombotic medications in combination with regional anesthesia has resulted in a need for more than “consensus statements” to safely manage regional interventions during anticoagulant/thromboprophylactic therapy.
Collapse
Affiliation(s)
- Jinlei Li
- Department of Anesthesiology, Yale University, Yale New Haven Hospital, New Haven, CT, USA
| | - Thomas Halaszynski
- Department of Anesthesiology, Yale University, Yale New Haven Hospital, New Haven, CT, USA
| |
Collapse
|
10
|
Muñoz González A, Cuello J, Rodríguez Cruz P, Iglesias Mohedano A, Domínguez Rubio R, Romero Delgado F, García Pastor A, Guzmán de Villoria Lebiedziejswki J, Fernández García P, Romero Martínez J, Ezpeleta Echevarri D, Díaz Otero F, Vázquez Alen P, Villanueva Osorio J, Gil Núñez A. Spontaneous spinal epidural haematoma: A retrospective study of a series of 13 cases. NEUROLOGÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.nrleng.2014.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
|
11
|
An analysis of the safety of epidural and spinal neuraxial anesthesia in more than 100,000 consecutive major lower extremity joint replacements. Reg Anesth Pain Med 2014; 38:515-9. [PMID: 24121606 DOI: 10.1097/aap.0000000000000009] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND OBJECTIVES A feared complication of spinal or epidural anesthesia is the development of epidural or spinal hematoma with subsequent neural element compression. Most available data are derived from the obstetric literature. Little is known about the frequency of hematoma occurrence among patients undergoing orthopedic joint arthroplasty, who are usually elderly and experience significant comorbidities. We sought to study the incidence of clinically significant lesions after spinal and epidural anesthesia and further describe their nature. METHODS We retrospectively analyzed a database of all patients who underwent total hip or total knee arthroplasty under neuraxial anesthesia at our institution between January 2000 and October 2010. Patients with radiographically confirmed epidural lesions were identified and further analyzed. RESULTS A total of 100,027 total knee and hip replacements under neuraxial anesthesia were performed at our institution. Ninety-seven patients underwent imaging studies to evaluate perioperative neurologic deficits (0.96/1000; 95% confidence interval, 0.77-1.16/1000). Eight patients were identified with findings of an epidural blood or gas collection (0.07/1000; 95% confidence interval, 0.02-0.13/1000). No patients receiving only spinal anesthesia were affected. All patients diagnosed with hematoma took at least 1 drug that potentially impaired coagulation (5 nonsteroidal anti-inflammatory agents, 1 a tricyclic antidepressant, and 1 an antiplatelet drug). No patient incurred persistent nerve damage. CONCLUSIONS The incidence of epidural/spinal complications found in this consecutive case series is relatively low but higher than previously reported in the nonobstetric population. Further research using large data sets could quantify the significance of some of the potentially contributing factors observed in this study.
Collapse
|
12
|
Muñoz González A, Cuello JP, Rodríguez Cruz PM, Iglesias Mohedano AM, Domínguez Rubio R, Romero Delgado F, García Pastor A, Guzmán de Villoria Lebiedziejswki J, Fernández García P, Romero Martínez J, Ezpeleta Echevarri D, Díaz Otero F, Vázquez Alen P, Villanueva Osorio JA, Gil Núñez A. Spontaneous spinal epidural haematoma: a retrospective study of a series of 13 cases. Neurologia 2014; 30:393-400. [PMID: 24839904 DOI: 10.1016/j.nrl.2014.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 02/26/2014] [Accepted: 03/10/2014] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Spontaneous spinal epidural haematoma (SSEH) has an estimated incidence of one per million inhabitants. It is classified as spontaneous when no identifiable cause can be linked to its onset. OBJECTIVE To describe a sample of patients with SSEH and analyse variables related to its functional prognosis. PATIENTS AND METHODS Retrospective study carried out in patients diagnosed with SSEH between 2001 and 2013 in our hospital. RESULTS We included 13 subjects (7 men) with a mean age of 71 years. Of the total, 62% had hypertension and 54% were treated with oral anticoagulants; of the latter, 57% had an International Normalised Ratio above 3. The most frequent manifestation was spinal column pain (85%). Nearly all subjects presented an associated neurological deficit, whether sensory-motor (70%), pure motor (15%), or pure sensory (7%). Five patients underwent surgical treatment and 8 had conservative treatment. After one year, 3 of the patients treated surgically and 4 of those on conservative treatment had a score of 2 or lower on the modified Rankin Scale. Poorer prognosis was observed in patients with anticoagulant therapy, large haematomas, location in the lumbar region, and more pronounced motor disability at onset. CONCLUSIONS Old age, hypertension, and anticoagulant therapy are the main risk factors for SSEH. The typical presentation consists of back pain with subsequent motor deficit. In patients with established motor symptoms, surgical treatment within the first 24hours seems to be the best option.
Collapse
Affiliation(s)
- A Muñoz González
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - J P Cuello
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - P M Rodríguez Cruz
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A M Iglesias Mohedano
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - R Domínguez Rubio
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - F Romero Delgado
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A García Pastor
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | - P Fernández García
- Servicio de Radiología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J Romero Martínez
- Servicio de Radiología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | - F Díaz Otero
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - P Vázquez Alen
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J A Villanueva Osorio
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A Gil Núñez
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| |
Collapse
|
13
|
Chrzescijanska E, Wudarska E, Kusmierek E, Rynkowski J. Study of acetylsalicylic acid electroreduction behavior at platinum electrode. J Electroanal Chem (Lausanne) 2014. [DOI: 10.1016/j.jelechem.2013.11.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
14
|
Wang L, Liu G, Subramaniam S, Wong TAKW, Kumar N. Spontaneous spinal epidural haematoma after antiplatelet treatment: a report of two cases. J Orthop Surg (Hong Kong) 2012; 20:386-90. [PMID: 23255653 DOI: 10.1177/230949901202000326] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We report 2 cases of spontaneous spinal epidural haematoma after antiplatelet treatment. One patient was on ticlodipine therapy and the other was on aspirin and clopidogrel. Both diagnoses were made using magnetic resonance imaging. One patient underwent multilevel laminectomies and posterior spinal fusion within 24 hours of symptom onset and achieved complete neurological recovery. The other underwent unilateral hemilaminectomies 40 hours after symptom onset and did not show neurological improvement. A high index of suspicion is needed for patients presenting with severe lower back pain and rapid neurological deterioration, especially in those on antiplatelet therapy. Urgent spinal cord decompression and epidural haematoma cord evacuation may provide more favourable outcome.
Collapse
Affiliation(s)
- Lushun Wang
- Department of Orthopaedics, National University Hospital, Singapore
| | | | | | | | | |
Collapse
|
15
|
Yang SM, Kang SH, Kim KT, Park SW, Lee WS. Spontaneous spinal epidural hematomas associated with acute myocardial infarction treatment. Korean Circ J 2012; 41:759-62. [PMID: 22259609 PMCID: PMC3257462 DOI: 10.4070/kcj.2011.41.12.759] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 03/22/2011] [Accepted: 03/28/2011] [Indexed: 01/30/2023] Open
Abstract
Many studies have reported spontaneous spinal epidural hematoma (SSEH). Although most cases are idiopathic, several are associated with thrombolytic therapy or anticoagulants. We report a case of SSEH coincident with acute myocardial infarction (AMI), which caused serious neurological deficits. A 56 year old man presented with chest pain accompanied with back and neck pain, which was regarded as an atypical symptom of AMI. He was treated with nitroglycerin, aspirin, low molecular weight heparin, and clopidogrel. A spinal magnetic resonance image taken after paraplegia developed 3 days after the initial symptoms revealed an epidural hematoma at the cervical and thoracolumbar spine. Despite emergent decompressive surgery, paraplegia has not improved 7 months after surgery. A SSEH should be considered when patients complain of abrupt, strong, and non-traumatic back and neck pain, particularly if they have no spinal pain history.
Collapse
Affiliation(s)
- Seung-Min Yang
- Department of Neurological Surgery, College of Medicine, Chung-Ang University, Seoul, Korea
| | | | | | | | | |
Collapse
|