Multifocal Calvarial Infarction with Epidural Hemorrhage in a Patient with Sickle Cell Vaso-Occlusive Crisis: A Case Report

While primarily a hematologic disease, sickle cell anemia is notorious for its multisystemic manifestations, particularly in episodes of vaso-occlusive crisis. Multifocal acute calvarial infarction with associated epidural hemorrhage has rarely been reported in sickle cell vaso-occlusive crisis. In this article, we reported a unique case of a 15-year-old male presenting with sickle cell vaso-occlusive crisis and neuroimaging findings of multifocal calvarial bone infarction and epidural hemorrhage. Radiologists and clinicians should be cognizant of this rare complication of sickle cell anemia to ensure appropriate diagnosis and timely treatment.

“WHAT MRI CAN DO IN SUSPECTED NON-DEGENRATIVE CASES OF COMPRESSIVE MYELOPATHY”

BACKGROUND: Compressive Myelopathy is described as the spinal cord compression either from outside or within the cord itself. Compression may be due to Herniated disc, post traumatic compression by fracture / displaced Vertebra, epidural hemorrhage / abscess or Epidural / Intradural (Intramedullary and Extramedullary) neoplasm. Study aimed to to study the role of MRI in evaluation of compressive myelopathy MATERIAL & METHOD: It is a cross sectional observational study conducted during Jan 2019 to June 2020 in patients presenting to the Department of Radiodiagnosis with features of compressive myelopathy at Sharda Hospital, SMS&R. Total of 30 patients who fullled inclusion criteria and provided the informed consent. Philips Achieva 3.0T MRI. Standard surface coils and body coils, were used for cervical, thoracic and Lumbar spine for acquisition of images was used to assess the compressive myelopathy. RESULTS: In present study, total of 30 patients were included in the present study. Among them 20 were males and 10 were female with the ratio of 2:1 showing the male predominance. The mean age of the patients was found to be 39.23 years. Extra dural compartment was the most commonly involved (n=26). POTTs (n=12) and TM (n=11) were most common located in extradural compartment, followed by metastasis (n=2). (p<0.001) CONCLUSION: MRI was able to successfully classify the spinal tumor based on Extradural / Intradural position and evaluate the integrity of the spinal cord, intervertebral disks and ligament following acute spinal trauma.

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

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.

Concomitant central venous sinus thrombosis and subdural hematoma in acute promyelocytic leukemia: middle meningeal artery embolization enables safe anticoagulation. Illustrative case

BACKGROUND Acute promyelocytic leukemia (APL) has long been associated with coagulation disorders. The proposed mechanism is a combination of fibrinolysis, proteolysis, platelet dysfunction, thrombocytopenia, and possibly disseminated intravascular coagulation. Hemorrhagic complications are prominent. OBSERVATIONS In this case, a 25-year-old female with newly diagnosed APL developed extensive cerebral venous thrombosis (CVT) and was initiated on a protocol with idarubicin and all-trans retinoic acid. The general recommendation for treating CVT is anticoagulation to stabilize the existing thrombus and prevent propagation. The patient was initiated on a heparin drip, but her clinical course was complicated by subdural hemorrhage (SDH) and epidural hemorrhage in the setting of thrombocytopenia. Anticoagulation was held, and her CVT propagated on follow-up imaging. To restart anticoagulation for CVT with a limited risk of SDH, the authors pursued middle meningeal artery (MMA) embolization. The patient was transitioned to apixaban and discharged to home. LESSONS MMA embolization enables safe anticoagulation in patients with concomitant CVT and SDH. The authors report the complex clinical course and effective management of this rare clinical scenario.

Abstract P639: Cerebrovascular and Pathological Findings in Police Chokehold Fatalities

Introduction: A number of recent well publicized deaths from police chokeholds have focused attention on the use and safety of chokeholds by law enforcement officers (LEO). LEO chokeholds are depicted as a safe non-lethal restraint technique. Use of chokeholds by LEO is purported to be in the middle range of force options when compared to other tools of force available. LEO chokeholds are often likened to judo chokeholds which have a long history of safety and have not directly contributed to the death of a judoka since the sport of Judo was founded in Japan in 1882. Some have posited that chokeholds employed by LEO are especially likely to be safe in young adults, as they are less likely to have underlying cardiovascular diseases. Chokeholds applied by LEO can unfortunately be associated with severe medical and neurological sequelae, including death. Methods: We reviewed autopsy data of 29 deaths associated with LEO chokeholds. Results: Subjects ranged in age from 19 to 58. Reported chokehold duration ranged from 4 seconds to 3 minutes in length. In ten cases, chokeholds were applied multiple times to a single subject. In one case chokeholds were applied five times to a single subject. At autopsy, two subjects were found to have carotid artery intimal tears. Two subjects had epidural hemorrhages. One subject sustained a subdural hemorrhage. One subject was found to have had a subarachnoid hemorrhage. Five subjects had pathology typical of global cerebral anoxia. One subject sustained multiple cervical spine fractures with crush injury to the spinal cord as well as spinal epidural hemorrhage. Two subjects had evidence of hemorrhage involving the cervical anterior longitudinal ligament. Atherosclerotic heart disease was found in five subjects. Two subjects had severe occlusive coronary artery disease. Four of these subjects were between the ages of 28 and 35. Myocardial fibrosis was found in five subjects. Cardiomegaly was found at autopsy in six subjects. Conclusions: LEO chokeholds are not widely considered to constitute deadly force, however our review of autopsy data from 29 deaths caused by chokeholds applied by LEO revealed that they can be associated with death and severe cerebrovascular, and central nervous system sequela in both young and older subjects.