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Jia T, Zhang H, Zeng Q. Paralysis of the lower limbs caused by spontaneous spinal epidural hematoma: A case report. Int J Surg Case Rep 2024; 114:109201. [PMID: 38171270 PMCID: PMC10800758 DOI: 10.1016/j.ijscr.2023.109201] [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: 11/17/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Spontaneous spinal epidural hematoma (SSEH) is a rare surgical emergency, often with acute onset, causing severe spinal cord injury. This report presents a case of SSEH treated by surgery to enhance understanding of this disease. CASE PRESENTATION A 76-year-old male patient sought medical care for unexplained sudden chest and back pain and paralysis of both lower extremities. Magnetic resonance imaging (MRI) confirmed the occupation of thoracolumbar spinal canal. The blood clot was completely removed by emergency surgery, and then the neurological function recovered. CLINICAL DISCUSSION Spontaneous spinal epidural hematoma is an uncommon disease, its acute onset, resulting in difficult to recover spinal cord injury, or even permanent paralysis. Therefore, early diagnosis and early operation are the key to the protection of neurological function. CONCLUSIONS Surgical intervention is the first choice for treatment, especially in acute and subacute spontaneous spinal epidural hematoma. Once diagnosed, and there are no contraindications, it is recommended to remove and decompress the hematoma as soon as possible.
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Affiliation(s)
- Tao Jia
- Department of Orthopaedics, Yueyang Hospital Affiliated to Hunan Normal University, Yueyang 414000, Hunan Province, China
| | - Hexin Zhang
- Department of Orthopaedics, Yueyang Hospital Affiliated to Hunan Normal University, Yueyang 414000, Hunan Province, China
| | - Qifang Zeng
- Department of Orthopaedics, Yueyang Hospital Affiliated to Hunan Normal University, Yueyang 414000, Hunan Province, China.
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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.
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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
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Wang M, Zhou P, Jiang S. Clinical Features, Management, and Prognostic Factors of Spontaneous Epidural Spinal Hematoma: Analysis of 24 Cases. World Neurosurg 2017; 102:360-369. [PMID: 28288922 DOI: 10.1016/j.wneu.2017.02.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/10/2017] [Accepted: 02/11/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Spontaneous spinal epidural hematoma (SSEH) is a rare neurosurgical emergency. It presents as acute spinal cord compression and usually requires surgical decompression. The patients who will benefit most from decompression surgery are unknown, and the factors associated with prognosis remain controversial. The purpose of our study was to identify the clinical features, treatments, and main factors related to the prognosis of SSEH. METHODS We reviewed the records of 24 patients treated for SSEH from September 2010 to January 2016 at West China Hospital. Clinical features, radiologic images, treatment methods, and clinical outcomes were reviewed retrospectively. To ascertain which factors were related to outcomes, statistical analysis was performed. RESULTS Among 24 patients, 19 presented with severe initial neurologic deficits (American Spinal Injury Association grade A-C) underwent decompressive surgery, and the remaining patients (initial American Spinal Injury Association grade D or E) received conservative treatment. Among the 19 patients in the operation group, seven (36.8%) had good outcomes, whereas 12 (63.2%) had poor outcomes. All patients in the conservative group had good outcomes. CONCLUSIONS SSEH is a rare but serious illness. It is more likely that SSEH arises from a ruptured internal vertebral venous plexus. The initial neurologic status is the determining factor influencing the treatment method and clinical outcome. The number of involved segments cannot be used to decide the treatment method or predict prognosis. Patients with shorter operative intervals appear to have better neurologic recovery.
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Affiliation(s)
- Mengmeng Wang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Peizhi Zhou
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Shu Jiang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
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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
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5
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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.
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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
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Sánchez Gutiérrez C, Alemán Martín A, Coronado Hijón V, Jiménez Delgado P. [Spontaneous resolution of a paraparesis due to a dorsolumbar epidural haematoma associated with subarachnoid anaesthesia and postoperative analgesia using an epidural catheter]. ACTA ACUST UNITED AC 2012; 59:503-6. [PMID: 22809578 DOI: 10.1016/j.redar.2012.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 05/23/2012] [Indexed: 11/24/2022]
Abstract
Spinal epidural haematoma after neuroaxial anaesthesia is a rare but serious complication. Most cases are attributed to anticoagulant therapy or bleeding tendency. It presents as an acute spinal cord compression and usually requires emergency surgical decompression. The interval between the onset of clinical signs and surgical evacuation is very important, influencing the neurological prognosis. We report a case of a spinal epidural haematoma after epidural analgesia in a patient who was treated with low molecular weight heparin for thrombo-prophylaxis in the perioperative period. In some cases, such as the one reported here, good neurological recovery can be achieved with conservative management.
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Affiliation(s)
- C Sánchez Gutiérrez
- Servicio de Anestesiología y Reanimación, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España.
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Hematoma epidural cervical yatrogénico. Presentación de un caso clínico y revisión de la literatura. Neurocirugia (Astur) 2011. [DOI: 10.1016/s1130-1473(11)70029-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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8
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Andole S, Wilson AO. Transient paraparesis as a consequence of spontaneous spinal epidural haematoma. BMJ Case Rep 2010; 2010:2010/nov30_1/bcr1020081089. [PMID: 22798313 DOI: 10.1136/bcr.10.2008.1089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 78-year-old man presented to the accident and emergency department following sudden onset of back pain, with attendant loss of power and sensation in the lower half of his body and urinary retention. Onset occurred while he was seated in a chair and he fell as he tried to get up. Neurological examination revealed symmetrical lower motor weakness (MRC grade 4/5) in both lower limbs with downgoing plantar reflexes. There was a clear sensory boundary at D4 with loss of joint position and sensation to light touch below this level. Rectal examination was unremarkable. While a CT head scan was normal, spinal MRI showed multilevel disc desiccations in the dorsal and lumbar spine. Additionally, in the dorsal spine at D4/5, there was a thin plaque of epidural tissue representing an epidural haematoma. Within 48-72 h the patient gradually and spontaneously regained full power.
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Affiliation(s)
- S Andole
- Geriatrics Department, Hemel Hempstead Hospital, Hemel Hempstead, Hertfordshire, UK.
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9
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Rispoli R, Mastrostefano R. Spontaneous spinal epidural haematoma. A case report. Neuroradiol J 2010; 23:85-9. [PMID: 24148338 DOI: 10.1177/197140091002300114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2009] [Accepted: 10/25/2009] [Indexed: 11/15/2022] Open
Abstract
Spinal epidural haematomas are infrequent events caused mainly by trauma or are iatrogenic following invasive spinal procedures (lumbar puncture, surgery or peridural anaesthesia). Spontaneous spinal epidural haematoma is a rare entity requiring emergency intervention in most cases. The incidence is estimated at about two to six cases per year. Early recognition, accurate diagnosis and rapid treatment may result in decreased morbidity and improved outcome. Here, we describe the case of a 60-year-old man who presented sudden paraplegia. Magnetic resonance imaging of thoracolumbar spine demonstrated an epidural mass extending from T11 to L1, causing spinal cord compression. Emergent decompressive surgery was performed and the patient had a significant improvement of neurologic deficits.
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Affiliation(s)
- R Rispoli
- Department of Neurosurgery, Località Tre Conche Hospital; Avezzano, Italy -
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10
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Spontaneous spinal epidural hematoma: An urgent complication of adding clopidogrel to aspirin therapy. J Neurol Sci 2009; 285:254-6. [DOI: 10.1016/j.jns.2009.06.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 06/11/2009] [Accepted: 06/12/2009] [Indexed: 11/20/2022]
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11
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Sánchez Rico P, Tomasa Irriguible TM, Catalán Eraso B, Martínez Vega S, Gener Raxach J, Klamburg I Pujol J. [Acute spontaneous spinal epidural hematoma]. Med Intensiva 2009; 33:54-5. [PMID: 19232210 DOI: 10.1016/s0210-5691(09)70306-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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12
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Recovery from acute paraplegia due to spontaneous spinal, epidural hematoma under minimal-dose acetyl-salicylic acid. Neurol Sci 2008; 29:271-3. [DOI: 10.1007/s10072-008-0980-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2008] [Indexed: 12/24/2022]
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13
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Morales Ciancio RA, Drain O, Rillardon L, Guigui P. Acute spontaneous spinal epidural hematoma: an important differential diagnosis in patients under clopidogrel therapy. Spine J 2008; 8:544-7. [PMID: 18455116 DOI: 10.1016/j.spinee.2006.11.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2006] [Revised: 11/27/2006] [Accepted: 11/29/2006] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spontaneous spinal epidural hematoma (SSEH) is an infrequent spinal pathology. Although it is related to numerous risk factors, its etiology remains unclear. PURPOSE The aim of this article was to review the most important data in the literature about SSEH and to propose clopidogrel (Plavix) therapy as a risk factor. STUDY DESIGN Case report. METHODS A 79-year-old woman was hospitalized in our unit with posterior thoracic pain and urinary retention of 72 hours duration. A clinical history was taken, and laboratory and imaging tests were performed. Urgent surgical decompression was performed, showing an epidural hematoma. Postoperative bacteriological cultures were negative, and microscopic analysis confirmed the diagnosis. RESULTS For this patient, clopidogrel (Plavix) therapy was the only risk factor related to SSEH. CONCLUSIONS In any patient under clopidogrel (Plavix): Sanofi-Synthelabo, Bristol-Myers Squibb/Sanofi Pharmaceuticals) therapy and with a typical clinical presentation, SSEH should be suspected and quickly diagnosed, regardless of hemostatic status or the absence of other major risk factors.
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Ruiz Garés T, Mateo JM, Longás Valién J, Aisa Hernández G, Cía Blasco P, Cuartero Lobera J. [Spinal cord compression by tumor with onset following epidural catheterization]. ACTA ACUST UNITED AC 2008; 55:119-21. [PMID: 18383975 DOI: 10.1016/s0034-9356(08)70520-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report the case of a 16-year-old boy with a pelvic tumor who developed signs of spinal cord compression following placement of a lumbar epidural catheter to obtain a percutaneous biopsy. The fact that a catheter had been inserted led us to suspect epidural hematoma as a complication, but surgery revealed that the pelvic tumor had spread to the lumbar epidural space and was causing motor blockade of both legs.
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MESH Headings
- Adolescent
- Analgesia, Epidural/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biopsy
- Combined Modality Therapy
- Cyclophosphamide/administration & dosage
- Diagnosis, Differential
- Doxorubicin/administration & dosage
- Hematoma, Epidural, Spinal/diagnosis
- Hematoma, Epidural, Spinal/etiology
- Hematoma, Epidural, Spinal/surgery
- Humans
- Laminectomy
- Lumbar Vertebrae/diagnostic imaging
- Lumbar Vertebrae/pathology
- Lumbar Vertebrae/surgery
- Magnetic Resonance Imaging
- Male
- Neoplasm Invasiveness
- Paraplegia/etiology
- Pelvic Neoplasms/complications
- Pelvic Neoplasms/diagnostic imaging
- Pelvic Neoplasms/drug therapy
- Pelvic Neoplasms/surgery
- Rhabdomyosarcoma, Embryonal/complications
- Rhabdomyosarcoma, Embryonal/diagnosis
- Rhabdomyosarcoma, Embryonal/drug therapy
- Rhabdomyosarcoma, Embryonal/secondary
- Rhabdomyosarcoma, Embryonal/surgery
- Spinal Cord Compression/diagnosis
- Spinal Cord Compression/etiology
- Spinal Neoplasms/complications
- Spinal Neoplasms/diagnosis
- Spinal Neoplasms/drug therapy
- Spinal Neoplasms/secondary
- Spinal Neoplasms/surgery
- Tomography, X-Ray Computed
- Vincristine/administration & dosage
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Affiliation(s)
- T Ruiz Garés
- Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital Clinico Universitario Lozano Blesa, Zaragoza
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Domenicucci M, Ramieri A, Salvati M, Brogna C, Raco A. Cervicothoracic epidural hematoma after chiropractic spinal manipulation therapy. Case report and review of the literature. J Neurosurg Spine 2007; 7:571-4. [PMID: 17977203 DOI: 10.3171/spi-07/11/571] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A spinal epidural hematoma is an extremely rare complication of cervical spine manipulation therapy (CSMT). The authors present the case of an adult woman, otherwise in good health, who developed Brown-Séquard syndrome after CSMT. Decompressive surgery performed within 8 hours after the onset of symptoms allowed for complete recovery of the patient's preoperative neurological deficit. The unique feature of this case was the magnetic resonance image showing increased signal intensity in the paraspinal musculature consistent with a contusion, which probably formed after SMT. The pertinent literature is also reviewed.
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Affiliation(s)
- Maurizio Domenicucci
- Department of Neurological Sciences, Neurosurgery, University of Rome "La Sapienza", Rome, Italy.
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Braun P, Kazmi K, Nogués-Meléndez P, Mas-Estellés F, Aparici-Robles F. MRI findings in spinal subdural and epidural hematomas. Eur J Radiol 2007; 64:119-25. [PMID: 17353109 DOI: 10.1016/j.ejrad.2007.02.014] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Revised: 02/06/2007] [Accepted: 02/13/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Spinal hematomas are rare entities that can be the cause of an acute spinal cord compression syndrome. Therefore, an early diagnosis is of great importance. PATIENTS AND METHODS From 2001 to 2005 seven patients with intense back pain and/or acute progressive neurological deficit were studied via 1.5 T MRI (in axial and sagittal T1- and T2-weighted sequences). Follow-up MRI was obtained in six patients. RESULTS Four patients showed the MRI features of a hyperacute spinal hematoma (two spinal subdural hematoma [SSH] and two spinal epidural hematoma [SEH]), isointense to the spinal cord on T1- and hyperintense on T2-weighted sequences. One patient had an early subacute SEH manifest as heterogeneous signal intensity with areas of high signal intensity on T1- and T2-weighted images. Another patient had a late subacute SSH with high signal intensity on T1- and T2-weighted sequences. The final patient had a SEH in the late chronic phase being hypointense on T1- and T2-weighted sequences. DISCUSSION MRI is valuable in diagnosing the presence, location and extent of spinal hematomas. Hyperacute spinal hematoma and the differentiation between SSH and SEH are particular diagnostic challenges. In addition, MRI is an important tool in the follow-up in patients with conservative treatment.
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Affiliation(s)
- Petra Braun
- Department of Radiology, Hospital La Plana, Ctra. De Vila-real a Borriana km. 0,5, 12540 Vila-real, Castelló, Spain.
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Hsieh CT, Chang CF, Lin EY, Tsai TH, Chiang YH, Ju DT. Spontaneous spinal epidural hematomas of cervical spine: report of 4 cases and literature review. Am J Emerg Med 2006; 24:736-40. [PMID: 16984848 DOI: 10.1016/j.ajem.2006.01.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2005] [Revised: 01/23/2006] [Accepted: 01/26/2006] [Indexed: 01/30/2023] Open
Affiliation(s)
- Cheng-Ta Hsieh
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, Republic of China.
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18
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Miñambres E, Burón J, Suberviola B, Hernández MA, González-Castro A, González-Mandly A. Nonsurgical management of symptomatic posttraumatic thoracic epidural hematoma. Am J Emerg Med 2005; 24:134-6. [PMID: 16338526 DOI: 10.1016/j.ajem.2005.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2005] [Accepted: 08/21/2005] [Indexed: 11/29/2022] Open
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Tripathi M, Nath SS, Gupta RK. Paraplegia after intracord injection during attempted epidural steroid injection in an awake-patient. Anesth Analg 2005; 101:1209-1211. [PMID: 16192546 DOI: 10.1213/01.ane.0000175765.76237.0a] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED Epidural steroid injection is recommended in patients with back ache from spinal and radicular pain or pain suggestive of radiculopathy. During needle placement and injections, clinicians often rely on the patient's complaint of paresthesia or shooting pain along the nerve root, dura, or cord in case a needle pierces these areas. We report the accidental intracord injection of steroid solution during epidural block using fluoroscopy in a conscious patient, which caused paraplegia. This case suggests failure of undue reliance on a patient reporting pain in the vicinity of needle puncturing the spinal cord structures. IMPLICATIONS Intracord injection of triamcinolone acetate and local anesthetic, resulting in permanent paraplegia, may occur in conscious patients.
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Affiliation(s)
- Mukesh Tripathi
- *Department of Anesthesiology, †Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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