A case of acute spinal epidural hematoma with chronic kidney disease, which was relieved by prompt surgery

Abstract

Keywords： spinal epidural hematoma, chronic kidney disease, hemodialysis, peritoneal dialysis, hematoma removal 〈Abstract〉 Spinal epidural hematomas are diseases in which hematoma formation causes neurological symptoms such as paralysis. Cerebrovascular disease is an important complication in patients with chronic kidney disease (CKD), but spinal epidural hematomas have rarely been reported. The patient was a 63 year old man with CKD G5A3, whose primary diseases were type 2 diabetes mellitus and hypertension. He had a history of stroke and exertional angina pectoris and was taking 100 mg aspirin. The patient was brought emergently by ambulance due to the sudden onset of posterior neck pain and limb paralysis during cervical extension exercises. A cervical spine MRI showed a hematoma at the C2 4 level, and a spinal epidural hematoma was diagnosed. He underwent immediate hematoma removal at the C2 5 level. Postoperatively, paralysis showed a trend towards improvement, and hand dexterity was restored. Hemodialysis was introduced and he was transferred for peritoneal dialysis after the improvement of paralysis. Spinal epidural hematoma may be difficult to differentiate from cerebral infarction and is considered to be a complication of CKD that requires attention, as associated factors such as abnormal blood coagulation and hypertension have been noted.