scholarly journals Spontaneous thoracolumbar epidural hematoma in an apixaban anticoagulated patient

2021 ◽  
Vol 12 ◽  
pp. 256
Author(s):  
Andreas Theofanopoulos ◽  
Petros Zampakis ◽  
Eleftheria Antoniadou ◽  
Dimitrios Papadakos ◽  
Dionysia Fermeli ◽  
...  
Keyword(s):  
Epidural Hematoma ◽  
Neurological Deficits ◽  
Mri Imaging ◽  
Significant Morbidity ◽  
Lower Extremity Weakness ◽  
Full Resolution ◽  
Neurological Morbidity ◽  
History Of ◽  
Anticoagulated Patient ◽  
Spinal Epidural

Background: Spontaneous spinal epidural hematomas (SSEHs) are often attributed to anticoagulation. Although they are rare, they may contribute to significant morbidity and mortality. Case Description: An 83-year-old female with a history of atrial fibrillation on apixaban, presented with 4 days of back pain, progressive lower extremity weakness and urinary retention. When the patient’s MRI showed a dorsal thoracolumbar SSEH, the patient underwent a T10–L3 laminectomy for hematoma evacuation. Within 2 postoperative months, her neurological deficits fully resolved. Conclusion: Apixaban is associated with SSEH resulting in severe neurological morbidity and even mortality. Prompt MRI imaging followed by emergency surgical decompressive surgery may result in full resolution of neurological deficits.

Posttraumatic Acute Spinal Epidural Hematoma of the Dorsolumbar Region

2020 ◽  
Vol 17 (01) ◽  
pp. 50-52
Author(s):  
Amit Agrawal ◽  
Uma Maheshwara Reddy V. ◽  
Kuraparthy Brinda ◽  
Luis R. Moscote-Salazar ◽  
Keerthana Dhanireddy
Keyword(s):  
Epidural Hematoma ◽  
Neurological Deficits ◽  
Spinal Epidural Hematoma ◽  
Mri Imaging ◽  
Common Occurrence ◽  
Resonance Imaging ◽  
Epidural Fat ◽  
Uncommon Case ◽  
Magnetic Resonance Imaging Mri ◽  
Spinal Epidural

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.

Experience in the surgical management of spontaneous spinal epidural hematoma

2004 ◽  
Vol 100 (1) ◽  
pp. 38-45 ◽  
Author(s):  
Cheng-Chih Liao ◽  
Shih-Tseng Lee ◽  
Wen-Chin Hsu ◽  
Li-Rong Chen ◽  
Tai-Ngar Lui ◽  
...  
Keyword(s):  
Epidural Hematoma ◽  
Anticoagulation Therapy ◽  
Neurological Deficits ◽  
Spinal Epidural Hematoma ◽  
Time Interval ◽  
Content Type ◽  
Spontaneous Spinal Epidural Hematoma ◽  
History Of ◽  
Spinal Epidural ◽  
Fine Print

Object. Spontaneous spinal epidural hematoma (SSEH) is a rare disease entity. Although many cases have been reported in the literature, controversy persists as to its origin, diagnosis, and timing of treatment. The authors conducted a study in patients treated in their hospital and report the results. Methods. Clinical data obtained in 35 patients with SSEH were retrospectively reviewed. Age, sex, history of hypertension, and history of anticoagulation therapy were recorded, and data were analyzed to clarify the possible predisposing factors of SSEH. Neurological outcomes were reappraised using a standardized grading system and correlated with the time interval from initial ictus to surgery, duration of complete neurological deficits, and the rapidity of deterioration of paralysis. Nonparametric methods and Spearman rank-correlation coefficients were used for statistical analysis. Conclusions. Surgery is a safe and effective procedure to treat SSEH. The disease-related mortality rate was 5.7%, the surgery-related complication rate was 2.9%, and there were no operation-related deaths. Neurological outcome after surgery is positively correlated with preoperative neurological deficits (88.9% complete recovery in patients with incomplete neurological deficits compared with 37.5% in those with complete deficits [p < 0.001]). In patients in whom the time interval from initial ictus was shorter (< 48 hours) and in whom the duration of complete neurological symptoms was also briefer (< 12 hours), there is a positive correlation with better neurological and functional recovery (p < 0.05).

scholarly journals A Spontaneous Spinal Epidural Hematoma Case Report

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Alvin Hendellyn
Keyword(s):  
Spinal Cord ◽  
Epidural Hematoma ◽  
Neurological Deficits ◽  
Spinal Epidural Hematoma ◽  
Spontaneous Spinal Epidural Hematoma ◽  
Factors Associated ◽  
Significant Clinical Improvement ◽  
History Of ◽  
Acute Paraparesis ◽  
Spinal Epidural

Hematoma epidural spinal spontan atau spontaneous spinal epidural hematoma (SSEH) adalah akumulasi darah di ruang epidural tulang belakang yang menekan medula spinalis dan menimbulkan defisit neurologis. SSEH dapat terjadi di segmen mana saja dari medula spinalis dan penyebab pasti serta sumber perdarahan yang pasti hingga saat ini masih belum diketahui. Diagnosis SSEH dapat ditegakkan dengan pemeriksaan penunjang MRI. Tatalaksana pilihan untuk kasus SSEH adalah laminektomi dekompresi dan evakuasi hematoma. Pada kasus ini, pasien datang dengan keluhan paraparesis inferior tipe UMN dan gangguan sensibilitas yang akut tanpa riwayat trauma dan faktor risiko yang berhubungan dengan SSEH. Pasien menjalani laminektomi dan menunjukkan perbaikan klinis yang signifikan. Spontaneous spinal epidural hematoma (SSEH) is an accumulation of blood in epidural space of the spine compressing spinal cord and causing neurological deficits. SSEH can occur in any segments of the spinal cord and the definite etiology and source of bleeding is still unknown until now. MRI can be used to support SSEH diagnosis. Treatment of choice for SSEH cases is decompression laminectomy and hematoma evacuation. In this case, the patient came with acute paraparesis upper motor neuron type and sensibility disturbances, without history of trauma and any risk factors associated with SSEH. The patient underwent laminectomy and showed significant clinical improvement.

scholarly journals Spinal Epidural Hematoma after Thoracolumbar Posterior Fusion Surgery without Decompression for Thoracic Vertebral Fracture

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Tsuyoki Minato ◽  
Masayuki Miyagi ◽  
Wataru Saito ◽  
Shintaro Shoji ◽  
Toshiyuki Nakazawa ◽  
...  
Keyword(s):  
Vertebral Fracture ◽  
Revision Surgery ◽  
Epidural Hematoma ◽  
Concrete Block ◽  
Posterior Fusion ◽  
Neurological Deficits ◽  
Spinal Epidural Hematoma ◽  
Decompression Surgery ◽  
Fusion Surgery ◽  
Spinal Epidural

We present a rare case of spinal epidural hematoma (SEH) after thoracolumbar posterior fusion without decompression surgery for a thoracic vertebral fracture. A 42-year-old man was hospitalized for a thoracic vertebral fracture caused by being sandwiched against his back on broken concrete block. Computed tomography revealed a T12 dislocation fracture of AO type B2, multiple bilateral rib fractures, and a right hemopneumothorax. Four days after the injury, in order to promote early orthostasis and to improve respiratory status, we performed thoracolumbar posterior fusion surgery without decompression; the patient had back pain but no neurological deficits. Three hours after surgery, he complained of acute pain and severe weakness of his bilateral lower extremities; with allodynia below the level of his umbilicus, postoperative SEH was diagnosed. We performed immediate revision surgery. After removal of the hematoma, his symptoms improved gradually, and he was discharged ambulatory one month after revision surgery. Through experience of this case, we should strongly consider the possibility of preexisting SEH before surgery, even in patients with no neurological deficits. We should also consider perioperative coagulopathy in patients with multiple trauma, as in this case.

scholarly journals Delayed traumatic spinal epidural hematoma with neurological deficits

2010 ◽  
Vol 8 (4) ◽  
pp. 477-479 ◽  
Author(s):  
Luciano Miller Reis Rodrigues ◽  
Felipe Abreu ◽  
Edison Noboru Fujiki ◽  
Carlo Milani
Keyword(s):  
Epidural Hematoma ◽  
Traumatic Event ◽  
Complete Recovery ◽  
Rehabilitation Program ◽  
Neurologic Deficit ◽  
Neurological Deficits ◽  
Spinal Epidural Hematoma ◽  
Variable Degree ◽  
Progressive Neurological Deficit ◽  
Spinal Epidural

ABSTRACT To describe the mechanism that causes spinal epidural hematoma with neurologic deficit and review the literature. We report a case of a 62-year-old man with post-traumatic epidural hematoma in the cervicothoracic spine, who developed progressive neurological deficit which eventually resulted in complete paralysis below T1. During surgical evacuation significant spine compression due to an organizing hematoma was observed. After surgery, the patient's motor function improved and there was a complete recovery of the neurologic deficit after a rehabilitation program. Conclusion: Epidural hematoma can happen after delayed traumatic event leading to a variable degree of neurologic damage.

scholarly journals Conservative Treatment of Acute Spontaneous Spinal Epidural Hematoma

1998 ◽  
Vol 25 (2) ◽  
pp. 159-163 ◽  
Author(s):  
Peter A. Pahapill ◽  
Stephen P. Lownie
Keyword(s):  
Epidural Hematoma ◽  
Standard Treatment ◽  
Surgical Intervention ◽  
Operative Therapy ◽  
Complete Recovery ◽  
Neurological Deficits ◽  
Spinal Epidural Hematoma ◽  
Spontaneous Spinal Epidural Hematoma ◽  
Spinal Epidural ◽  
Sustained Recovery

ABSTRACT:Background:In cases of acute spontaneous spinal epidural hematoma producing neurological deficits, emergency surgical evacuation is the standard treatment.Methods:Such a case is presented in which complete resolution of neurological deficits occurred without surgical intervention.Results:This is the fifth reported case of complete recovery in a patient managed conservatively. In most reports, significant and sustained neurological recovery had occurred within 12 hours of impairment of walking.Conclusion:In cases of acute spontaneous spinal epidural hematoma in which neurological deterioration is followed by early and sustained recovery, non-operative therapy may be considered.

Spontaneous Ventral Spinal Epidural Hematoma with Anterior Cord Syndrome

Neurosurgery ◽  
1981 ◽  
Vol 9 (4) ◽  
pp. 440-443 ◽  
Author(s):  
Timothy W. Phillips ◽  
Thomas F. Kling ◽  
John E. McGillicuddy
Keyword(s):  
Spinal Canal ◽  
Epidural Hematoma ◽  
Neurological Deficits ◽  
Posterolateral Approach ◽  
Spinal Epidural Hematoma ◽  
Disseminated Intravascular Coagulopathy ◽  
Thoracic Epidural ◽  
Intravascular Coagulopathy ◽  
Spinal Epidural

Abstract The authors report a case of spontaneous ventral thoracic epidural hematoma presenting as an anterior cord syndrome. The epidural hematoma ws evacuated through a posterolateral approach to the spinal canal. A disseminated intravascular coagulopathy appeared intraoperatively. By 3 months after operation the neurological deficits had cleared.

Surgical treatment of spontaneous spinal epidural hematoma: a 5-year experience

2009 ◽  
Vol 11 (4) ◽  
pp. 480-486 ◽  
Author(s):  
Cheng-Chih Liao ◽  
Po-Chuan Hsieh ◽  
Tzu-Kang Lin ◽  
Chih-Lung Lin ◽  
Yang-Lan Lo ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Hospital Stay ◽  
Functional Recovery ◽  
Epidural Hematoma ◽  
Length Of Hospital Stay ◽  
Neurological Deficits ◽  
Spinal Epidural Hematoma ◽  
Management Options ◽  
Spontaneous Spinal Epidural Hematoma ◽  
Spinal Epidural

Object Spontaneous spinal epidural hematoma (SSEH) is a rare disease. The goal of this study was to clarify the treatment results and management options in SSEH. Methods Patients with SSEH who were surgically treated in the authors' center between June 2003 and June 2008 were included in this study. Patients were treated as early as possible if their neurological deficits were incomplete or had been complete for 12 hours or less. The patients were assigned to 1 of 2 groups based on completeness of preoperative cord dysfunction (complete vs incomplete deficit). Surgical outcomes of the 2 groups were compared by functional performance, coded as Nurick grades at 1, 3, and 6 months after the operation. Also compared were duration of hospital stay and the number of days needed to regain the ability to function independently (defined as Nurick Grades 1 and 2) after the operation. Results There were 17 patients (7 female and 10 male) with pathologically confirmed SSEH. Coagulopathy, greater size (length) of SSEH, and preoperative complete spinal dysfunction were found to contribute to poor postoperative functional recovery (p < 0.05). Patients with incomplete preoperative deficits (ASIA Impairment Scale Grades B, C, and D) were able to achieve functional independent recovery within a month after surgery and had significantly better outcomes (lower Nurick grades) at 1, 3, and 6 months postoperatively than those with complete deficits (p < 0.001, p = 0.027, and p = 0.027, respectively). Median time to independent functional recovery and median length of hospital stay were significantly shorter in patients with incomplete preoperative deficits than in those with complete deficits (6 vs 110 and 9 vs 58 days, respectively; both p < 0.001). Conclusions Impaired preoperative hemostasis contributes to larger size of SSEH, high probability of postoperative recurrence of spinal epidural hematoma, and poor functional recovery following surgical evacuation. Incomplete spinal cord dysfunction before surgery predicts good outcome and warrants emergent evacuation of SSEH especially in the cervical and thoracic regions, where the clots are located in proximity to the spinal cord.

scholarly journals The natural history of cerebral cavernous malformations in children

2016 ◽  
Vol 17 (2) ◽  
pp. 123-128 ◽  
Author(s):  
Bradley A. Gross ◽  
Rose Du ◽  
Darren B. Orbach ◽  
R. Michael Scott ◽  
Edward R. Smith
Keyword(s):  
Risk Factors ◽  
Family History ◽  
Natural History ◽  
Significant Risk ◽  
Neurological Deficits ◽  
Cerebral Cavernous Malformations ◽  
Similar Data ◽  
Cavernous Malformations ◽  
Neurological Morbidity ◽  
History Of

OBJECT Cerebral cavernous malformations (CMs) are a source of neurological morbidity from seizures and focal neurological deficits due to mass effect and hemorrhage. Although several natural history reports exist for adults with CMs, similar data for pediatric patients are limited. METHODS The authors reviewed hospital databases to identify children with CMs who had not been treated surgically and who had clinical and radiological follow-up. Annual hemorrhage rates were calculated in lesion-years, and risk factors were assessed using the Cox proportional hazards model. RESULTS In a cohort of 167 patients with 222 CMs, the mean patient age at the time of diagnosis was 10.1 years old (SD 6.0). Ninety patients (54%) were male. One hundred four patients (62%) presented with hemorrhage from at least 1 CM, 58 (35%) with seizures with or without CM hemorrhage, and 43 (26%) with incidental lesions. Twenty-five patients (15%) had multiple CMs, 17 (10%) had a family history of CMs, and 33 (20%) had radiologically apparent developmental venous anomalies (DVAs). The overall annual hemorrhage rate was 3.3%. Permanent neurological morbidity was 29% per hemorrhage, increasing to 45% for brainstem, thalamic, or basal ganglia CM and decreasing to 15% for supratentorial lobar or cerebellar lesions. The annual hemorrhage rate for incidental CMs was 0.5%; for hemorrhagic CMs, it was 11.3%, increasing to 18.2% within the first 3 years. Hemorrhage clustering within 3 years was statistically significant (HR 6.1, 95% CI 1.72–21.7, p = 0.005). On multivariate analysis, hemorrhagic presentation (HR 4.63, 95% CI 1.53–14.1, p = 0.007), brainstem location (HR 4.42, 95% CI 1.57–12.4, p = 0.005), and an associated radiologically apparent DVA (HR 2.91, 95% CI 1.04–8.09, p = 0.04) emerged as significant risk factors for hemorrhage, whereas age, sex, CM multiplicity, and CM family history did not. CONCLUSIONS Prior hemorrhage, brainstem location, and associated DVAs are significant risk factors for symptomatic hemorrhage in children with CMs. Hemorrhage clustering within the first 3 years of a bleed can occur, a potentially important factor in patient management and counseling.

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