A case of acute spinal epidural hematoma in a patient with antiplatelet therapy

The authors report a case of acute spinal epidural hematoma occurring in a patient receiving antiplatelet drugs. A 76-year-old man with a history of cerebral infarction had been taking antiplatelet agents for one year. He suddenly developed severe back pain which woke him from sleep, and numbness of his lower extremities was then noted. He was hospitalized 15 hours later. Neurological examination revealed flaccid paralysis of both lower extremities with negative Babinski's reflex, and sensory disturbance below the level of L1. The bleeding time and prothrombin time were prolonged. Computed tomographic (CT) scan revealed a biconvex, relatively hyperdense mass in the posterior spinal canal at the level of T12. Metrizamide myelography disclosed an incomplete blockage caused by an epidural mass at the level of T11. Post-myelographic CT scan demonstrated a sharply demarcated extradural filling defect at the level of T11. Seventeen hours after the onset of symptoms, an emergency laminectomy was performed extending from T12 to L3, and the epidural clot was totally evacuated. Histological examination of the capsule of the hematoma revealed no vascular anomalies. The patient made a good postoperative recovery. To the authors' knowledge, this is the first reported case of spontaneous intraspinal hemorrhage in a patient taking antiplatelet drugs. Acute onset of persistent pain anywhere along the spinal axis and the development of spinal neurological deficits in a patient on antiplatelet therapy should raise the suspicion of a spinal epidural hematoma. It should be stressed that prompt neuroradiological diagnosis and rapid surgical decompression are essential to allow good recovery. The present case illustrates that neurological emergencies can occur in patients receiving antiplatelet therapy.     

Epidural hematoma following epidural catheter placement in a patient with chronic renal failure

PURPOSE: We report a case of epidural hematoma in a surgical patient with chronic renal failure who received an epidural catheter for postoperative analgesia. Symptoms of epidural hematoma occurred about 60 hr after epidural catheter placement. CLINICAL FEATURES: A 58-yr-old woman with a history of chronic renal failure was admitted for elective abdominal cancer surgery. Preoperative laboratory values revealed anemia, hematocrit 26%, and normal platelet, PT and PTT values. General anesthesia was administered for surgery, along with epidural catheter placement for postoperative analgesia. Following uneventful surgery, the patient completed an uneventful postoperative course for 48 hr. Then, the onset of severe low back pain, accompanied by motor and sensory deficits in the lower extremities, alerted the anesthesia team to the development of an epidural hematoma extending from T12 to L2 with spinal cord compression. Emergency decompressive laminectomy resulted in recovery of moderate neurologic function. CONCLUSIONS: We report the first case of epidural hematoma formation in a surgical patient with chronic renal failure (CRF) and epidural postoperative analgesia. The only risk factor for the development of epidural hematoma was a history of CRF High-risk patients should be monitored closely for early signs of cord compression such as severe back pain, motor or sensory deficits. An opioid or opioid/local anesthetic epidural solution, rather than local anesthetic infusion alone, may allow continuous monitoring of neurological function and be a prudent choice in high-risk patients. If spinal hematoma is suspected, immediate MRI or CT scan should be done and decompressive laminectomy performed without delay.     

Spontaneous spinal epidural hematoma in a pregnant patient

Spontaneous spinal epidural hematoma is a rare occurrence during pregnancy with only five cases described in the literature since 1900. Even in the general population, the frequency of spontaneous spinal epidural hematoma is extremely low and the etiology unclear. Several theories exist for the cause of spontaneous spinal epidural hematoma, however, none has gained uniform acceptance. A case of spontaneous spinal epidural hematoma during pregnancy in a 27-year-old, gravida 2, para 1, female at term with 36 hours duration of both paresthesia and progressive weakness of the lower extremities is presented. In addition, all previous known cases are summarized, including outcome. We hypothesize that the cause of spontaneous spinal epidural hematoma is multifactorial, and pregnancy-induced structural changes in arterial walls and hemodynamic changes may play a role. In addition, we postulate that the origin of the bleeding is arterial, rather then venous. Lastly, the symptoms, diagnosis, and management of spontaneous spinal epidural hematoma during pregnancy are discussed.     

Spontaneous cerebrospinal fluid rhinorrhea associated with chronic renal failure--case report.

A 39-year-old woman was admitted with complaints of headache and nasal discharge on the left for 3 months which was later on proved to be cerebrospinal fluid (CSF). Neurological examination found no abnormalities except bilateral papilledema. Neuroimaging demonstrated enlargement of the lamina cribrosa foramina through which the olfactory nerves pass, as well as empty sella and cerebral cortical atrophy. Bone mineral densitometry showed osteopenia. CSF Ca++ and blood parathyroid hormone levels were elevated. CSF pressure was 280 mmH2O. Bilateral frontal craniotomy was performed to expose the anterior fossa. Foraminal enlargement at the lamina cribrosa was confirmed, and islands of extra-osseous calcifications on the arachnoid membrane were identified. The base of the anterior fossa was repaired intradurally with fascial graft and fibrin glue on both sides. No CSF leakage was noted at 1-year follow up. Spontaneous CSF leakage probably resulted from enlargement of the foramina at the lamina cribrosa due to Ca++ mobilization from bones and pseudotumor cerebri not to the extent of hydrocephalus caused by poor CSF absorption at the arachnoid granulations obliterated by extra-osseous calcareous accumulation.     

Epidural hematoma after spinal anesthesia in a patient with undiagnosed epidural lymphoma

The incidence of hemorrhagic complications after neuroaxial anesthesia is very infrequent. We report a case of a woman developing epidural bleeding 3 wk after performing an uneventful spinal anesthesia at the lumbar level L3-4 for removal of a wire loop in her left knee. No hemostasis altering medication had been taken before and after spinal puncture. The hematoma presenting at the lumbar level L2-3 had to be removed via laminectomy. Pathological examination of the hematoma revealed a highly vascularized centroblastic non-Hodgkin's lymphoma that was not diagnosed before surgery. The patient did not develop any neurological deficits. IMPLICATIONS: We report a case of a women developing epidural bleeding 3 wk after performing an uneventful spinal anesthesia for removal of a wire loop in her left knee. Pathological examination of the neurosurgically removed hematoma revealed a highly vascularized epidural centroblastic non-Hodgkin lymphoma.     

自发性颈椎椎管内硬膜外血肿1例报告

自发性椎管内硬膜外血肿（spontaneous spinal epidural hematoma,SSEH）在临床上较少见,起病隐匿,进展迅速,常常因为认识不足导致误诊而错过最佳治疗时机,影响预后,甚至出现永久性神经功能损伤。我们收治1例自发性颈椎硬膜外血肿患者,报道如下。     

Acute epidural hematoma in a patient with Glanzmann's thrombasthenia: case report

A 7-year-old girl with Glanzmann's thrombasthenia (GT) fell and hit her head against a table. Within 2 hours she began to vomit and became drowsy. On admission to our hospital her Glasgow Coma Scale score was 13. Computed tomography (CT) on admission showed acute epidural hematoma in the left posterior fossa. We administered platelets, performed emergent lateral suboccipital craniotomy, and totally removed the epidural hematoma. Postoperative CT showed no evidence of hematoma or re-bleeding. She was discharged without neurological deficits 14 days after the operation. GT is a platelet aggregation disorder due to a functional loss of platelet membrane glycoprotein IIb/IIIa. The present patient with GT underwent successful emergency craniotomy after platelet transfusion.     

慢性自发性腰椎管内硬膜外血肿1例

正患者,男,77岁,因"腰痛伴双下肢麻木、疼痛、无力8年,加重2个月"于2016年11月7日入院。患者8年前腰痛,伴双下肢麻木、无力,间歇性跛行,2个月前无明显诱因出现腰痛明显加重伴双侧臀部疼痛,站立行走时疼痛明显,并伴尿频、尿急。查体:腰背部压痛、叩痛明显,伴双侧臀部放射痛,腰椎屈伸活动受限明显,右小腿及足部针刺觉减弱,双侧胫前肌肌力Ⅳ级,双拇趾背伸肌力Ⅲ级,双足跖屈肌力     

自发性椎管内硬膜外血肿2例报告

<正>自发性椎管内硬膜外血肿(spontaneous spinal epidural hematoma,SSEH)在临床较为少见,原因不明,临床易漏诊误诊,并可能导致永久性神经功能损害。2014年9月~2015年9月,我院脊柱骨科收治了2例SSEH患者,报道如下。病例1,女,76岁,因"突发双下肢瘫痪5d"于2014年9月9日入院。患者于5d前无明显诱因突发胸背部疼痛,后出现双下肢感觉及运动消失,伴大小便失禁。遂至当地医院住院治疗,MRI检查提示T7~L1椎管后部硬膜外长梭形病变,考虑血管畸形或血管瘤破裂出血伴血肿形成可能     

自发性脊髓硬膜外和硬膜下血肿

目的 探讨自发性脊髓硬膜外血肿（SSEH)及硬膜下血肿(SSSH)的病因、临床特点、诊治方法及预后相关因素。方法 自1995～2002年收治的4例SSEH及2例SSSH患者．均在静息或轻微活动后发病，发病前均无感染或服药史，其中1例63岁患者诉有高血压病史．1例65岁患者入院检查后发现患有Ⅱ型精尿病．余均否认患有其他疾病。所有患者均表现为突发性的颈、肩、胸、背部疼痛，数分钟到数小时内出现肢体运动、感觉障碍、大小便障碍及潴留，5例患者有抻经根放射痛症状．有3例行腰穿，压力无明显增高．均行手术治疗．手术距发病时间10～16d．平均12.5d，手术均在局麻下进行．4例SSEH患者行患部全椎板切除血肿清除术．2例SSSH患者行全椎板切除并硬静膜切开血肿清除，硬脊膜修补术。结果 均经MR检查、手术及病理证实。MRI显示椎管后方或后外方占位性病变，T1加权能特征性地反映血肿随时间发生的信号变化而最有价值．T22加权可很好地判断血肿的位置，患者预后与术前的神经功能状态及发病至手术的时间密切相关，本组患者随访6～18个月，平均10个月．6例患者除大、小便功能有不同程度的改善外．5例患者肢体的运动、感觉功能无明显恢复，1例SSSH患者感觉消失平面下降，右上肢肌力较前增强，结论 自发性脊髓硬膜外及硬膜下血肿是一种少见病，MRI是其首选的检查方法，应当注意的是早期诊断并及时手术是治疗SSEH和SSSH．防止永久性神经功能障碍的关健。     

Spontaneous spinal epidural hematoma diagnosed by MRI: a case report

Appropriate diagnostic procedure for spinal epidural hematomas has not been established yet. The authors reported a case of spontaneous epidural hematomas at the thoracic level, in which correct diagnosis was made with MRI and good results were obtained by surgery. A 63-year-old female experienced a severe back pain which appeared suddenly during a walk and was followed by motor weakness in both legs deteriorating quickly to paraplegia. The patient had no history of hypertension, trauma or bleeding tendency. The laboratory data were normal. On admission, neurological examination revealed flaccid paraplegia, total sensory loss below the level of Th 6 and urinary and fecal incontinence. Myelograms showed incomplete block at the Th 6 level and postmyelographic CT scan showed an isodense mass, which was suspected to be an epidural tumor located behind the spinal cord. Emergent MRI confirmed an epidural hematoma as a high intensity area extending from Th 3 through Th 11. Sixty-five hours after onset, laminectomy of Th 4 through Th 11 and the evacuation of epidural hematoma were performed without identification of the origin of the bleeding. Neither vascular malformation nor tumor was recognized during operation. Neither was it noticed on histological examination. The patient made favorable progress after the surgery. During the first two weeks in the postoperative period, she regained muscle strength enough to do standing exercise, and satisfactory improvement was made in sensory function including urination and defecation. We emphasize that MRI is indispensable to make a differential diagnosis of thoracic lesions. In the reported case, a correct diagnosis was made with MRI, and an extremely good result was obtained by an emergency operation.     

Spontaneous spinal epidural hematoma

Two cases of the spontaneous occurrence of spinal epidural hematomas of the high thoracic area are reported. Both acute and subacute presentations of paraplegia are represented. Neither patient had experienced any significant antecedent trauma. No predisposing medical conditions were present. Both patients recovered to independent ambulation following timely operative intervention. The pertinent literature on spinal epidural hematomas is reviewed, and the differential diagnosis of this entity is discussed. The need for prompt diagnosis and surgical treatment to achieve the best neurological outcome is emphasized.     

Spinal epidural hematoma in a scoliotic patient with long fusion: a case report.

BACKGROUND CONTEXT: This is the only reported case on a spinal epidural hematoma occurring in a fused scoliotic segment. PURPOSE: To report the first case of a spinal epidural hematoma developed within the fused segment of a scoliotic curve and to raise clinicians' awareness of the pathology of a spinal epidural hematoma. STUDY DESIGN/SETTING: A case report. PATIENT SAMPLE: A 53-year-old woman with long spinal fusion for severe kyphoscoliosis diagnosed as a teenager. OUTCOME MEASURES: Neurological improvement and clinical follow-up for any occult spinal fracture. METHODS: A patient was surgically treated for a spinal epidural hematoma causing paraparesis. Clinical and radiological features were reported. RESULTS: The etiology of this case could not be defined, although the patient had a minor fall injury. Radiography and computed tomography scans could not detect any obvious fracture. Magnetic resonance imaging showed typical features of an epidural hematoma. After the hematoma evacuation, the patient's neurology gradually improved. CONCLUSIONS: Long fusion, differential stiffness along the fusion block, implant removal, and significant residual deformity may increase the risk of an epidural hematoma formation after trivial trauma without an obvious fracture on imaging. Clinicians should be mindful of this possibility and look out for any hematoma in the fused segment(s).     

Differences of acute and chronic epidural hematoma]

Standard neurosurgical management demands prompt evacuation of all extradural hematomas to obtain a low incidence of mortality and morbidity. In selected cases some authors have suggested that moderate hematomas can be managed conservatively without risk to the patient and with a normal outcome. The goal of this study was to analyze the differences in preoperative clinical parameters between a group of acute and a group of chronic extradural hematomas (chronic extradural hematoma was defined as a delay of more than 72 h from the accident to diagnosis). One hundred fifteen (115) patients with extradural hematomas underwent a standard evaluation, documentation and neurosurgical management (prompt evacuation of all extradural hematomas through a craniotomy). Ninety-five patients (83%) had an acute extradural hematoma. Twenty patients (17%) had a chronic extradural hematoma. We analyzed the following parameters: age, cause of accident, clinical findings, Glasgow Coma Score, morphology of hematoma, location of hematoma, cause of bleeding and clinical outcome. The mean age (chronic 30/acute 32) and age distribution were not significantly different between groups. There were no differences in the cause of accident. All patients in both groups had skull fractures. There was no difference between groups regarding hematoma location, most of there being located in the temporal fossa. In the group of acute extradural hematomas, 62% of patients had a Glasgow Coma Score of less than 8 and 47% had pupillary dilation. In the group of chronic extradural hematomas, moderate clinical symptoms were found, with headache and discrete psychological changes most common. Eighty percent (80%) of the patients had a Glasgow Coma Score of greater than 13 and no patients had pupillary dilation.(ABSTRACT TRUNCATED AT 250 WORDS)     

针刺致颈椎管硬膜下外血肿1例

正患者,男,56岁,因"颈部疼痛2 d,加重伴头痛6 h"入院。患者2 d前因失眠在我院针灸科门诊行针刺(风池穴)治疗后即稍感颈部疼痛。1 d前来院复查,医生未予重视,仍给予针刺(风池穴)治疗后患者回家。6 h前出现颈部剧烈疼痛,伴头疼、右侧肢体麻木,麻木水平呈进行性上升,遂再来我院复查。既往有高血压病史10年,不规律服用降压药物,血压波动在130~160/80~90 mmHg;1年前因冠心病行冠状