A case of spontaneous thoracolumbar epidural hematoma in Covid-19 pneumonia

Abstract

Introduction and importance Covid-19 is an important disease that still occupies our agenda, and as time passes, we have been observing its extrapulmonary manifestations. In this study, we presented a case of spontaneous thoracolumbar epidural hematoma, which we could not attribute to any cause other than Covid-19. Case presentation We presented a 55-year-old female patient whose etiology could not be found to be compatible with the literature. In the formation of this disease, we did not have any positive findings except for Covid-19, which she had 20 days ago. The patient had no history of anticoagulant or antiaggregant drug use. He had no history of trauma and no signs. Hematological tests were normal. We evacuated the hematoma in the T12-L1 vertebral canal after laminectomy and the pathology result was compatible with hematoma. Clinical discussion Although spontaneous spinal epidural hematoma is rare, many factors are blamed for its etiology. Many extrapulmonary complications of Covid-19 stand out in the literature. The fact that the patient had Covid-19 did not affect the neurosurgical approach, but we think that it is useful to examine the complaints of patients with Covid-19 more systematically. Conclusion Spontaneous spinal epidural hematomas are rare. Making the correct diagnosis often takes time and is difficult. Decompression surgery is at the forefront as a treatment option. However, conservative treatment can be performed in suitable patients. As we saw in this case, we should consider Covid-19 among the etiological causes.

Spontaneous Cervical Epidural Hematoma Following COVID-19 Illness Presenting to a Chiropractor: A Case Report

“…To our knowledge, this case is the first report of a chiropractor identifying SEH. As the patient had no specific risk factors for SEH and diclofenac is not associated with SEH to our knowledge [14], it seems possible given other similar recent studies [5][6][7][8] that his COVID-19 illness could have been a predisposing factor for SEH.…”

“…According to a search of PubMed and Google Scholar on November 18, 2022, we identified four previously published cases of spontaneous SEH in patients following COVID-19 infection [5][6][7][8]. Several mechanisms have been suggested to explain these events, including venous thromboembolism, disseminated intravascular coagulation, increased pressure in the epidural venous plexus, and vasculitis [5][6][7], however, there is no clear unifying pathophysiological explanation. In addition, larger studies have identified an association between COVID-19 and other conditions involving bleeding such as intracranial hemorrhage and spontaneous muscle hematoma [9,10].…”

“…In addition, recent case reports have suggested that SEH may develop as a complication of coronavirus disease 2019 (COVID-19) [5][6][7][8]. While research relating SEH to COVID-19 is limited, recent systematic reviews have suggested that several bleeding conditions such as intracranial hemorrhage and muscle hematomas are also potential complications of COVID-19 [9,10].…”

Spontaneous intramedullary hematoma following COVID‐19 vaccination: A case report

“…Lim et al 18 reported a cervical spine spontaneous epidural hematoma in a COVID‐19‐infected woman treated conservatively. Zubeyde et al 5 reported another epidural hematoma in an older woman positive for SARS‐CoV‐2 virus that underwent laminectomy and hematoma evacuation.…”

“… 1 , 2 Myelitis, neuropathy, spinal cord dysfunction, and hemorrhagic lesions are amongst the reported spinal manifestations of SARS‐CoV‐2. 2 , 3 , 4 , 5 …”