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Laouar F, Bouzerara O, Sadaoui B, Boublata L. Spontaneous spinal subdural hematoma associated with intracranial idiopathic subarachnoid hemorrhage. A case report and review of the literature. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101458] [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] Open
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Extent of spinal canal obliteration as prognostic factor for functional outcome in patients with spontaneous spinal epidural hematoma: a retrospective study. Acta Neurochir (Wien) 2021; 163:3279-3286. [PMID: 34633546 DOI: 10.1007/s00701-021-05011-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 09/16/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Spontaneous spinal epidural hematoma (SSEDH) is a rare condition with potentially devastating consequences. Known prognostic factors are short time to surgery, preoperative neurologic condition, and age. The aim of this study was to investigate the impact of the transversal hematoma extent with its subsequent spinal canal obliteration on outcome in patients with SSEDH. METHODS A retrospective study including all patients that underwent surgery due to SSEDH at the University Hospital of St. Poelten between 1/7/2005 and 30/6/2020 was conducted. The percentage of spinal canal obliteration at the level where the hematoma was most prominent was calculated and correlated to functional outcome. RESULTS A total of 17 patients could be included in this study. Preoperative ASIA impairment scale showed positive correlation with postoperative outcome (p = 0.005). Patients with a favorable outcome (ASIA D and E) showed a statistically significant lower mean obliteration of the spinal canal by the hematoma with 46.4% (± 8%) in comparison to patients with an unfavorable outcome with 62.1% (± 6%, p = 0.001). A cut-off of 51% yielded a sensitivity and specificity for favorable outcome of 100% and 70% respectively (area under the ROC 0.93, p < 0.001). CONCLUSION Preoperative percentage of spinal canal obliteration is statistically significant lower in patients with favorable outcome in surgically treated patients with spontaneous spinal epidural hematoma.
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Agrawal A, V. UMR, Brinda K, Moscote-Salazar LR, Dhanireddy K. Posttraumatic Acute Spinal Epidural Hematoma of the Dorsolumbar Region. INDIAN JOURNAL OF NEUROTRAUMA 2020. [DOI: 10.1055/s-0040-1713076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AbstractIn spite of the relative common occurrence of spinal injuries, spinal epidural hematomas (SEHs) are rare lesions. Depending on the onset, site, size, and presence of neurological deficits, they can be treated conservatively or surgically. In the presented article, we report an uncommon case of posttraumatic dorsolumbar SEH and discuss the characteristic magnetic resonance imaging (MRI) imaging findings of epidural fat in the cases of traumatic spinal hematomas.
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Affiliation(s)
- Amit Agrawal
- Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
| | - Uma Maheshwara Reddy V.
- Department of Radiology, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
| | - Kuraparthy Brinda
- Department of Anesthesia, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
| | - Luis R. Moscote-Salazar
- Faculty of Medicine, Neurosurgeon-Critical Care, Center for Biomedical Research (CIB), University of Cartagena, Cartagena de Indias, Bolivar, Colombia
| | - Keerthana Dhanireddy
- Department of Radiology, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
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Tamburrelli FC, Meluzio MC, Masci G, Perna A, Burrofato A, Proietti L. Etiopathogenesis of Traumatic Spinal Epidural Hematoma. Neurospine 2018; 15:101-107. [PMID: 29656630 PMCID: PMC5944636 DOI: 10.14245/ns.1834938.469] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 02/07/2018] [Accepted: 02/13/2018] [Indexed: 12/22/2022] Open
Abstract
Spinal epidural hematoma (SEH) is a rare cause of nerve root or cord compression; its pathogenesis is not always clearly recognizable. The aim of this paper was to investigate possible etiopathological factors in a consecutive series of patients affected by traumatic SEH treated at our institution. Seven patients with neurologic impairment due to traumatic SEH were retrospectively analyzed after diagnosis and surgical treatment. Thoracic localization was found in 5 cases, and lumbar and cervical localization were found in 1 patient each. One patient was affected by ankylosing spondylitis and one by diffuse idiopathic skeletal hyperostosis. SEH was associated with spine fractures in 6 cases. Only 2 cases of traumatic SEH resulted from high-energy trauma. All patients underwent surgical decompression within 24 hours after admittance to the hospital. Three patients recovered completely, 3 remained paraplegic, and 1 remained monoplegic. Several concomitant conditions are suggested to be predisposing factors for the development of SEH, although its inherent mechanism is still unknown. Two patients in the present series were affected by rheumatologic disorders, confirming the elevated incidence of hematomas in such patients compared to the normal population. Three very unusual cases of SEH occurred in senile patients affected by osteoporotic fractures. Early diagnosis and urgent decompression of the hematoma remain mandatory.
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Affiliation(s)
| | - Maria Concetta Meluzio
- Division of Spinal Surgery, Department of Orthopedics, Catholic University of Sacred Heart, Rome, Italy
| | - Giulia Masci
- Division of Spinal Surgery, Department of Orthopedics, Catholic University of Sacred Heart, Rome, Italy
| | - Andrea Perna
- Division of Spinal Surgery, Department of Orthopedics, Catholic University of Sacred Heart, Rome, Italy
| | - Aaron Burrofato
- Division of Spinal Surgery, Department of Orthopedics, Catholic University of Sacred Heart, Rome, Italy
| | - Luca Proietti
- Division of Spinal Surgery, Department of Orthopedics, Catholic University of Sacred Heart, Rome, Italy
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Wolfe AR, Faroqui RM, Visvikis GA, Mantello MT, Perel AB, Tewari SO. Spinal subarachnoid and subdural hematoma presenting as a Brown-Séquard-like myelopathy following minor trauma in a patient on dabigatran etexilate. Radiol Case Rep 2017; 12:257-260. [PMID: 28491164 PMCID: PMC5417756 DOI: 10.1016/j.radcr.2017.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/24/2017] [Accepted: 02/05/2017] [Indexed: 11/29/2022] Open
Abstract
Dabigatran etexilate is a relatively new anticoagulant from the class of direct thrombin inhibitors which is administered orally and does not require routine blood work monitoring. Dabigatran may be attractive to both clinicians and patients because of both its convenience and efficacy; however, clinical complications are still being elucidated. Here, we present a previously unreported case of spinal subarachnoid and subdural hematoma presenting as a Brown-Séquard-like myelopathy in a patient after minor trauma in the setting of Dabigatran anticoagulation.
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Affiliation(s)
- Allen R Wolfe
- Department of Radiology, Richmond University Medical Center, Staten Island, NY 11310
| | - Raihan M Faroqui
- College of Medicine, American University of Antigua, University Park, Coolidge, Antigua 41900, West Indies
| | - George A Visvikis
- Department of Radiology, Richmond University Medical Center, Staten Island, NY 11310
| | - Michael T Mantello
- Department of Radiology, Richmond University Medical Center, Staten Island, NY 11310
| | - Allan B Perel
- Department of Neurology, Richmond University Medical Center, Staten Island, NY 11310
| | - Sanjit O Tewari
- Department of Radiology, Richmond University Medical Center, Staten Island, NY 11310
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Karataş L, Mengi G, Özyemişçi-Taşkıran Ö. A missed Behçet's case presenting with spontaneous epidural hematoma. Eur J Rheumatol 2015; 2:167-168. [PMID: 27708958 DOI: 10.5152/eurjrheum.2015.0011] [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: 02/08/2015] [Accepted: 02/25/2015] [Indexed: 11/22/2022] Open
Abstract
Spinal vascular events related to Behçet's disease are relatively uncommon. Deep vein thrombosis is the most frequent vascular involvement. Anticoagulant therapy is a debated issue in Behçet's disease. In this case report, we present a patient with a delayed diagnosis of Behçet's disease after development of cervical epidural hematoma following anticoagulant therapy due to deep venous thrombosis. Anticoagulant therapy without immunosuppressive therapy leading to uncontrolled systemic inflammation may be the cause of spinal epidural hematoma. On the other hand, epidural vascular involvement as a vasculitic manifestation of Behçet's disease in conjunction with anticoagulant therapy may have predisposed to spontaneous bleeding via increased fragility or microaneurysms in epidural arteries. In this case report, the importance of a multidisciplinary approach to Behçet's disease is emphasized.
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Affiliation(s)
- Levent Karataş
- Department of Physical Medicine and Rehabilitation, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Gönen Mengi
- Department of Rheumatology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Özden Özyemişçi-Taşkıran
- Department of Physical Medicine and Rehabilitation, Koç University Faculty of Medicine, İstanbul, Turkey
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Castillo JM, Afanador HF, Manjarrez E, Morales XA. Non-Traumatic Spontaneous Spinal Subdural Hematoma in a Patient with Non-Valvular Atrial Fibrillation During Treatment with Rivaroxaban. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:377-81. [PMID: 26090890 PMCID: PMC4479261 DOI: 10.12659/ajcr.893320] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, 69 Final Diagnosis: Spontaneous spinal subdural hematoma Symptoms: Paraplegia Medication: Rivaroxaban Clinical Procedure: — Specialty: General Internal Medicine • Hospital Medicine • Cardiology • Hematology • Neurology
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Affiliation(s)
- Jessica M Castillo
- Department of Internal Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL, USA
| | - Hayley F Afanador
- Department of Internal Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL, USA
| | - Efren Manjarrez
- Department of Internal Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL, USA
| | - Ximena A Morales
- Department of Internal Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL, USA
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Kim T, Lee CH, Hyun SJ, Yoon SH, Kim KJ, Kim HJ. Clinical Outcomes of Spontaneous Spinal Epidural Hematoma : A Comparative Study between Conservative and Surgical Treatment. J Korean Neurosurg Soc 2012; 52:523-7. [PMID: 23346323 PMCID: PMC3550419 DOI: 10.3340/jkns.2012.52.6.523] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 09/07/2012] [Accepted: 12/18/2012] [Indexed: 12/17/2022] Open
Abstract
Objective The incidence of spontaneous spinal epidural hematoma (SSEH) is rare. Patients with SSEH, however, present disabling neurologic deficits. Clinical outcomes are variable among patients. To evaluate the adequate treatment method according to initial patients' neurological status and clinical outcome with comparison of variables affecting the clinical outcome. Methods We included 15 patients suffered from SSEH. Patients were divided into two groups by treatment method. Initial neurological status and clinical outcomes were assessed by the American Spinal Injury Association (ASIA) impairment scale. Also sagittal hematoma location and length of involved segment was analyzed with magnetic resonance images. Other factors such as age, sex, premorbid medication and duration of hospital stay were reviewed with medical records. Nonparametric statistical analysis and subgroup analysis were performed to overcome small sample size. Results Among fifteen patients, ten patients underwent decompressive surgery, and remaining five were treated with conservative therapy. Patients showed no different initial neurologic status between treatment groups. Initial neurologic status was strongly associated with neurological recovery (p=0.030). Factors that did not seem to affect clinical outcomes included : age, sex, length of the involved spinal segment, sagittal location of hematoma, premorbid medication of antiplatelets or anticoagulants, and treatment methods. Conclusion For the management of SSEH, early decompressive surgery is usually recommended. However, conservative management can also be feasible in selective patients who present neurologic status as ASIA scale E or in whom early recovery of function has initiated with ASIA scale C or D.
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Affiliation(s)
- Tackeun Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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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.
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Affiliation(s)
- Lushun Wang
- Department of Orthopaedics, National University Hospital, Singapore
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Blood product support for delivery in severe factor X deficiency: the use of thrombin generation to guide therapy. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2010; 5:204-9. [PMID: 19204776 DOI: 10.2450/2007.0023-07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Accepted: 07/02/2007] [Indexed: 11/21/2022]
Abstract
BACKGROUND Severe FX deficiency is a rare disorder with a variable bleeding tendency but spontaneous life threatening haemorrhage can occur. Treatment for invasive procedures and spontaneous bleeding is with prothrombin complex concentrates (PCC). When used in large or repetitive doses these are associated with a thrombotic tendency. FX:C levels of 0.15 - 0.30 IU/ mL are thought to be haemostatic during surgery . There is only limited information on the outcome and management of pregnancy in severe FX deficiency. Caesarean section is suggested as delivery mode to reduce the risk of intracranial/abdominal neonatal haemorrhage, but successful vaginal deliveries are also described. The calibrated automated thrombin generation assay (CAT) is a global coagulation test that measures the time course of thrombin generation. It has been reported to correlate with prothrombotic states and the severity of bleeding in rare coagulation disorders. The variability in phenotype, the uncertainty of the minimal haemostatic FX:C concentration and the association of PCC's with thrombosis make thrombin generation of interest in the management of FX deficient patients. PATIENT We describe the use of CAT as a possible means to monitor treatment with PCC (Beriplex) in a patient with severe FX deficiency (FX:C < 0.01 IU/mL) during successful vaginal delivery and epidural anaesthesia. RESULTS Thrombin generation was normal at FX:C 0.80 IU/mL but only borderline normal at FX:C 0.25 IU/mL. Repetitive doses over 3 days increased thrombin generation to the upper limit of normal at FX:C 0.25 IU/mL consistent with a prothrombotic tendency after multiple doses. The increase in thrombin generation was not related to prothrombin levels. CONCLUSION The data suggest that CAT may be used to monitor treatment with PCC in FX deficiency. Higher levels than previously thought may be needed to normalize thrombin generation. Further studies into the correlation with bleeding or thrombosis are needed before the approach can be accepted in clinical practice.
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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.
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Abstract
Spinal cord hematomas are remarkably uncommon. Even more rare are spontaneous spinal subdural hematomas without underlying pathological changes. In some patients, compression of the spinal cord by spinal subdural hematoma has led to acute paraplegia. Spontaneous spinal subdural hematomas occur most often in the thoracic spine and are manifested by sudden back pain that radiates to the upper or lower extremities or to the trunk and variable degrees of motor, sensory, and autonomic disturbances. Clinicians should consider spontaneous spinal subdural hematoma when patients who are taking anticoagulants report back or radicular pain and the development of paraparesis, because early diagnosis is essential for preventing irreversible paralysis. Diagnosis of spontaneous spinal subdural hematoma requires prompt radiological assessment; magnetic resonance imaging is the preferred method. Treatment includes emergent decompressive laminectomy and evacuation of the hematoma to prevent or minimize permanent neurological damage caused by spinal cord compression, ischemia, and spinal cord injury.
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Affiliation(s)
- Rebecca Anne Dampeer
- Rebecca Anne Dampeer is a registered nurse who is a preceptor in the coronary care unit at Carilion Roanoke Memorial Hospital, Roanoke, Virginia
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Breivik H, Bang U, Jalonen J, Vigfússon G, Alahuhta S, Lagerkranser M. Nordic guidelines for neuraxial blocks in disturbed haemostasis from the Scandinavian Society of Anaesthesiology and Intensive Care Medicine. Acta Anaesthesiol Scand 2010; 54:16-41. [PMID: 19839941 DOI: 10.1111/j.1399-6576.2009.02089.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Central neuraxial blocks (CNBs) for surgery and analgesia are an important part of anaesthesia practice in the Nordic countries. More active thromboprophylaxis with potent antihaemostatic drugs has increased the risk of bleeding into the spinal canal. National guidelines for minimizing this risk in patients who benefit from such blocks vary in their recommendations for safe practice. METHODS The Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) appointed a task force of experts to establish a Nordic consensus on recommendations for best clinical practice in providing effective and safe CNBs in patients with an increased risk of bleeding. We performed a literature search and expert evaluation of evidence for (1) the possible benefits of CNBs on the outcome of anaesthesia and surgery, for (2) risks of spinal bleeding from hereditary and acquired bleeding disorders and antihaemostatic drugs used in surgical patients for thromboprophylaxis, for (3) risk evaluation in published case reports, and for (4) recommendations in published national guidelines. Proposals from the taskforce were available for feedback on the SSAI web-page during the summer of 2008. RESULTS Neuraxial blocks can improve comfort and reduce morbidity (strong evidence) and mortality (moderate evidence) after surgical procedures. Haemostatic disorders, antihaemostatic drugs, anatomical abnormalities of the spine and spinal blood vessels, elderly patients, and renal and hepatic impairment are risk factors for spinal bleeding (strong evidence). Published national guidelines are mainly based on experts' opinions (weak evidence). The task force reached a consensus on Nordic guidelines, mainly based on our experts' opinions, but we acknowledge different practices in heparinization during vascular surgery and peri-operative administration of non-steroidal anti-inflammatory drugs during neuraxial blocks. CONCLUSIONS Experts from the five Nordic countries offer consensus recommendations for safe clinical practice of neuraxial blocks and how to minimize the risks of serious complications from spinal bleeding. A brief version of the recommendations is available on http://www.ssai.info.
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Affiliation(s)
- H Breivik
- Section for Anaesthesiology and Intensive Care Medicine, University of Oslo, Rikshospitalet, Oslo, Norway.
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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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Elwood D, Koo C. Intraspinal Hematoma Following Neuraxial Anesthesia and Low-Molecular-Weight Heparin in Two Patients: Risks and Benefits of Anticoagulation. PM R 2009; 1:389-96. [DOI: 10.1016/j.pmrj.2008.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Revised: 11/21/2008] [Accepted: 11/29/2008] [Indexed: 11/26/2022]
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Spontaneous Spinal Epidural Hematoma in Pregnancy Associated With Using Low Molecular Weight Heparin. Obstet Gynecol 2009; 113:532-533. [DOI: 10.1097/aog.0b013e31818f52d1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Spinal strokes. HANDBOOK OF CLINICAL NEUROLOGY 2008. [PMID: 18804675 DOI: 10.1016/s0072-9752(08)93034-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
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Corbett SM, Rebuck JA. Medication-related complications in the trauma patient. J Intensive Care Med 2008; 23:91-108. [PMID: 18372349 DOI: 10.1177/0885066607312966] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Trauma patients are twice as likely to have adverse reactions to medication as nontrauma patients. The need for medication in trauma patients is high. Surgery is often necessary, and immunosuppression and hypercoagulability may be present. Adverse drug events can be caused in part by altered pharmacokinetics, drug interactions, and polypharmacy. Medications may also have serious long-term adverse effects, which must be considered. It is not the purpose of this review article to discuss all adverse effects of all medications. This article will discuss the more common adverse effects of medications for trauma patients in the acute care setting, in the following categories: pain control, sedation, antibiotics, seizure prophylaxis in head trauma, atrial fibrillation, deep vein thrombosis and pulmonary embolism prophylaxis, hemodynamic support, adrenal insufficiency, factor VIIa.
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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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Birkenmaier C, Seitz S, Wegener B, Glaser C, Ruge MI, von Liebe A, von Schulze Pellengahr C. Acute paraplegia after vertebroplasty caused by epidural hemorrhage. A case report. J Bone Joint Surg Am 2007; 89:1827-31. [PMID: 17671024 DOI: 10.2106/jbjs.f.01612] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Christof Birkenmaier
- Department of Orthopedic Surgery, Grosshadern Medical Center, University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
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N'dri Oka D, Aesch B, Jan M. [Acute non-traumatic extensive subdural spinal hematoma]. Neurochirurgie 2007; 53:292-5. [PMID: 17602712 DOI: 10.1016/j.neuchi.2007.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2006] [Accepted: 03/26/2007] [Indexed: 10/19/2022]
Abstract
Acute spinal subdural hematoma is a somewhat rare pathology. Its severity comes from the constitution of an acute spinal cord compression. In many cases MRI is useful for the differential diagnosis with the epidural hematoma. A 79-year-old patient was referred for emergency neurosurgery for acute spinal cord compression. The vascular risk in this patient was significant: hypertension, oral anticoagulants. Clinically, acute non-traumatic subdural spinal hematoma was suspected. The spinal cord MRI was in favor of the diagnosis which was confirmed intraoperatively. The surgical procedure revealed an extensive hematoma which infiltrated the spinal cord. The diagnosis of nontraumatic subdural spinal hematoma may be difficult in some cases and correctly established only during the surgical procedure. In comparison with reports in the literature, we discuss the underlying mechanisms of this hematoma. Spinal subdural haematoma must be considered in patients taking anticoagulant therapy or with a coagulation disorder who present signs of acute spinal cord compression. MRI sagittal T1 and T2-weighted images are adequate and reliable for diagnosis of spinal subdural hematoma. Prompt surgical evacuation of this hematoma is crucial.
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Affiliation(s)
- D N'dri Oka
- Service de neurochirurgie, hôpital Bretonneau, 2 bis, boulevard Tonnellé, 37044 Tours cedex, France.
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