Acute spontaneous spinal epidural hematoma: an important differential diagnosis in patients under clopidogrel therapy. |
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| Authors: | Ruben Alejandro Morales Ciancio Olivier Drain Ludovic Rillardon Pierre Guigui |
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| Affiliation: | 1. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH;2. Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, OH;3. Department of Vascular Surgery, Mike O''Callaghan Federal Medical Center, Las Vegas, NV;1. Service de chirurgie orthopédique et traumatologique, CHU Edouard-Herriot, 5, place d’Arsonval, 69003 Lyon, France;2. Service de chirurgie orthopédique et traumatologique, CHU Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France;3. Service de chirurgie orthopédique et traumatologique, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France;4. Clinique Mont-Louis, 8, rue de la Folie-Regnault, 75011 Paris, France;1. Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Ankara, Turkey;2. Department of Radiology, Ibn-i Sina Hospital, Ankara University School of Medicine, Ankara, Turkey |
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| 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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