scholarly journals Cauda equina syndrome caused by multiple intraspinal hemorrhage following percutaneous coronary intervention: a case report and a review of the literature

2021 ◽  
Author(s):  
Yong-Kuan Lim ◽  
Pin-Yuan Chen ◽  
Wei-Siang Chen ◽  
Yu-Cheng Kao ◽  
Mei-Mei Lin ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Subdural Hematoma ◽  
Epidural Hematoma ◽  
Dual Antiplatelet Therapy ◽  
Cauda Equina ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Spinal Subdural Hematoma ◽  
Epidural Hemorrhage ◽  
Spinal Epidural

Abstract Background Percutaneous coronary intervention and dual antiplatelet therapy are common management for patients with coronary artery disease. Multiple spontaneous intraspinal hematomas mixed with epidural hematoma and subdural hematoma following regular percutaneous coronary intervention is an extremely rare complication. We describe our experiences to treat the elderly who presented with spontaneous spinal epidural hematoma and subdural hematoma in different spinal locations after percutaneous coronary intervention. Neurological examination and magnetic resonance imaging were followed to assess the treatment outcomes for more than 2.5 years. Case presentation: In this article, we present a 70 years-old male taking dual antiplatelet therapy for 1 year after drug-eluting stents implantation to right coronary artery and left anterior descending artery for non-ST elevation myocardial infarction had a sudden onset of paraplegia then the autonomic dysfunction immediately after another percutaneous coronary intervention. Whole spinal MRI showed mixed spontaneous spinal subdural hematoma and spinal subdural hematoma, included: anterior C5-T3 acute subdural hemorrhage, right lateral T4 to T8 epidural hemorrhage, and L5-S1 intrathecal hematoma. After urgent cauda equina neurolysis and T7-9 laminectomy to evacuate spinal epidural hemorrhage in accordance with the neurological symptoms, the patient regained walking ability immediately. The urination and defecation function recovered then. The surgical results maintained for at less 2.5 years, even after another percutaneous coronary intervention 1 year later. Conclusions Intraspinal hematomas in acute coronary syndromes are scarce but critical conditions after percutaneous coronary intervention. Multiple mixed spontaneous spinal subdural hematoma/ epidural hematoma could be fully reversed by circumspect neurolysis and limited laminectomy timely.

TWILIGHT: A Randomized Trial of Ticagrelor Monotherapy Versus Ticagrelor Plus Aspirin Beginning at 3 Months in High-risk Patients Undergoing Percutaneous Coronary Intervention

2020 ◽  
Vol 14 ◽  
Author(s):  
Johny Nicolas ◽  
Usman Baber ◽  
Roxana Mehran
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Coronary Intervention ◽  
Bleeding Events ◽  
High Risk Patients ◽  
Risk Of Death ◽  
Percutaneous Coronary ◽  
Risk Patients

A P2Y12 inhibitor-based monotherapy after a short period of dual antiplatelet therapy is emerging as a plausible strategy to decrease bleeding events in high-risk patients receiving dual antiplatelet therapy after percutaneous coronary intervention. Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention (TWILIGHT), a randomized double-blind trial, tested this approach by dropping aspirin at 3 months and continuing with ticagrelor monotherapy for an additional 12 months. The study enrolled 9,006 patients, of whom 7,119 who tolerated 3 months of dual antiplatelet therapy were randomized after 3 months into two arms: ticagrelor plus placebo and ticagrelor plus aspirin. The primary endpoint of interest, Bleeding Academic Research Consortium type 2, 3, or 5 bleeding, occurred less frequently in the experimental arm (HR 0.56; 95% CI [0.45–0.68]; p<0.001), whereas the secondary endpoint of ischemic events was similar between the two arms (HR 0.99; 95% CI [0.78–1.25]). Transition from dual antiplatelet therapy consisting of ticagrelor plus aspirin to ticagrelor-based monotherapy in high-risk patients at 3 months after percutaneous coronary intervention resulted in a lower risk of bleeding events without an increase in risk of death, MI, or stroke.

scholarly journals Spinal subdural hematoma and subdural anesthesia following combined spinal–epidural anesthesia: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yanmei Bi ◽  
Junying Zhou
Keyword(s):  
Epidural Anesthesia ◽  
Subdural Hematoma ◽  
Cauda Equina ◽  
Vital Signs ◽  
Epidural Administration ◽  
Single Shot ◽  
Combined Spinal Epidural ◽  
Spinal Subdural Hematoma ◽  
Combined Spinal Epidural Anesthesia ◽  
Spinal Epidural

Abstract Background Subdural anesthesia and spinal subdural hematoma are rare complications of combined spinal-epidural anesthesia. We present a patient who developed both after multiple attempts to achieve combined spinal–epidural anesthesia. Case presentation A 21-year-old parturient, gravida 1, para 1, with twin pregnancy at gestational age 34+ 5 weeks underwent cesarean delivery. Routine combined spinal–epidural anesthesia was planned; however, no cerebrospinal fluid outflow was achieved after several attempts. Bupivacaine (2.5 mL) administered via a spinal needle only achieved asymmetric blockade of the lower extremities, reaching T12. Then, epidural administration of low-dose 2-chlorprocaine caused unexpected blockade above T2 as well as tinnitus, dyspnea, and inability to speak. The patient was intubated, and the twins were delivered. Ten minutes after the operation, the patient was awake with normal tidal volume. The endotracheal tube was removed, and she was transferred to the intensive care unit for further observation. Postoperative magnetic resonance imaging suggested a spinal subdural hematoma extending from T12 to the cauda equina. Sensory and motor function completely recovered 5 h after surgery. She denied headache, low back pain, or other neurologic deficit. The patient was discharged 6 days after surgery. One month later, repeat MRI was normal. Conclusions All anesthesiologists should be aware of the possibility of SSDH and subdural block when performing neuraxial anesthesia, especially in patients in whom puncture is difficult. Less traumatic methods of achieving anesthesia, such as epidural anesthesia, single-shot spinal anesthesia, or general anesthesia should be considered in these patients. Furthermore, vital signs and neurologic function should be closely monitored during and after surgery.

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