Paraplegia due to spinal epidural hematoma after mitral valve surgery: Report of a case

Abstract

Spinal epidural hematomas are rare entities that can be associated with spinal traumatic injuries and vascular lesions or that can spontaneously arise. Several reports have linked these hematomas to heart valve surgery. We herein describe a 71-year-old female patient who developed postoperative paraplegia immediately after mitral valve repair. Magnetic resonance imaging revealed an epidural hematoma of the spinal cord from C7 to Th4. A laminectomy was not performed because the patient's paraplegia gradually improved. After continuous rehabilitation, the patient regained sufficient muscle strength to perform standing exercises. She is presently capable of routine activities at home and is undergoing bethanechol chloride treatment for a neurogenic urinary bladder. Motor and sensory deficits of both lower limbs in a patient that arise immediately after heart surgery must be examined by early imaging to rule out space-occupying pathologies such as spinal epidural hematomas.

Epidural catheterization in cardiac surgery: The 2012 risk assessment

“…[92] Cases of spontaneous epidural hematoma without an epidural catheter after cardiac surgery are also described. [93][94][95][96] Hayashi et al, reported a 71-year-old women, who underwent mitral valvoplasty with CPB. [95] Surgery lasted around 4 h uneventfully, and she was not previously treated with any anticoagulant therapy.…”

“…[93][94][95][96] Hayashi et al, reported a 71-year-old women, who underwent mitral valvoplasty with CPB. [95] Surgery lasted around 4 h uneventfully, and she was not previously treated with any anticoagulant therapy. One hour after surgery, paraplegia was noted, an epidural hematoma compressing the spinal cord at the C7-T4 level was revealed on MR imaging.…”

Spontaneous Spinal Epidural Hematoma Causing Paraparesis in a Patient of Mitral Valve Replacement with Anticoagulant Treatment – A Decision Dilemma

“…SSEH is a rare surgical emergency and accounts for <1% of all spinal epidural lesions, with an estimated annual incidence of only 0.1/1,00,000 [11]. Precipitating factors associated with SSEH include traumatic spinal injuries, blood dyscrasia, anticoagulation therapy, spinal and epidural anesthesia, lumbar puncture, Paget's disease, tumor genesis, and arteriovenous malformation [12, 13,14]. Therefore, etiology of SSEH in our case may be anticoagulant therapy due to mitral valve replacement.…”