Spinal Chronic Subdural Hematoma in Association With Anticoagulant Therapy

Jimbo, Hiroyuki; Asamoto, Shunji; Mitsuyama, Tetsuryu; Hatayama, Kazumi; Iwasaki, Yasuo; Fukui, Yasuyuki

doi:10.1097/01.brs.0000202760.30257.88

Cited by 38 publications

(29 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the 17 previously reported trauma cases, 11 patients had slipped or fallen, 3 had fallen from some height, and 1 patient was involved in a traffic accident. In those cases both the hips and head may have suffered trauma.…”

Section: Discussionmentioning

confidence: 99%

“…Of 12 previously reported cases of spontaneous SDH, 5 (42%) involved patients with a bleeding tendency; 3 of these patients had blood dyscrasia, and 2 had been treated with drugs that can affect bleeding. 9,11,18,38,44 Interestingly, among the 17 earlier trauma patients, 7 (41%) also had a bleeding tendency, 1 presented with blood dyscrasia, and 6 were on drug therapy that can affect bleeding. 7,17,20,29,30,40,41 The patient in our Case 1 also had a history of myelo dysplastic syndrome and hemorrhagic diathesis.…”

Section: Discussionmentioning

confidence: 99%

“…Of these cases, 3 involved patients who had undergone ventricu loperitoneal (VP) shunt placement, 31,37,42 3 cases were postcraniotomy, 26,36,43 17 were posttrauma, 1,4,5,7,8,13,17,20,21,24,29,30,34,35,[39][40][41] and in 12 cases the SDH arose spontaneous ly. [9][10][11]16,18,22,25,28,30,38,44,45 Leakage of intracranial SDH fluid into the spinal subdural space may be involved in patients who manifest spinal SDH after VP shunt placement. Low CSF pressure is a risk factor for spinal SDH 13,15,26,43 in the absence of intracranial SDH extension, and low CSF pressure syndrome elicited by the overflow of CSF in the VP shunt may result in concomitant hemorrhages.…”

Section: Discussionmentioning

confidence: 99%

“…Of 29 earlier patients with posttraumatic or spon taneous hematomas, 1,3,5,[7][8][9][10][11]13,[16][17][18][20][21][22]24,25,[28][29][30][31][34][35][36][37][38][39][40][41][42][43][44][45] 11 had undergone surgery, 2 aspiration by lumbar puncture, and 16 had been placed under observation. In both of our pa tients with concomitant asymptomatic spinal SDH the lesions resolved spontaneously with conservative man agement.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Prospective assessment of concomitant lumbar and chronic subdural hematoma: is migration from the intracranial space involved in their manifestation?

Kokubo

Kim

Mishina

et al. 2014

SPI

View full text Add to dashboard Cite

Object Spinal subdural hematomas (SDHs) are rare and some are concomitant with intracranial SDH. Their pathogenesis and etiology remain to be elucidated although their migration from the intracranial space has been suggested. The authors postulated that if migration plays a major role, patients with intracranial SDH may harbor asymptomatic lumbar SDH. The authors performed a prospective study on the incidence of spinal SDH in patients with intracranial SDH to determine whether migration is a key factor in their concomitance. Methods The authors evaluated lumbar MR images obtained in 168 patients (125 males, 43 females, mean age 75.6 years) with intracranial chronic SDH to identify cases of concomitant lumbar SDH. In all cases, the lumbar MRI studies were performed within the 1st week after surgical irrigation of the intracranial SDH. Results Of the 168 patients, 2 (1.2%) harbored a concomitant lumbar SDH; both had a history of trauma to both the head and the hip and/or lumbar area. One was an 83-year-old man with prostate cancer and myelodysplastic syndrome who suffered trauma to his head and lumbar area in a fall from his bed. The other was a 70-year-old man who had hit his head and lumbar area in a fall. Neither patient manifested neurological deficits and their hematomas disappeared under observation. None of the patients with concomitant lumbar SDH had sustained head trauma only, indicating that trauma to the hip or lumbar region is significantly related to the concomitance of SDH (p < 0.05). Conclusions As the incidence of concomitant lumbar and intracranial chronic SDH is rare and both patients in this study had sustained a direct impact to the head and hips, the authors suggest that the major mechanism underlying their concomitant SDH was double trauma. Another possible explanation is hemorrhagic diathesis and low CSF syndrome.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Prospective assessment of concomitant lumbar and chronic subdural hematoma: is migration from the intracranial space involved in their manifestation?

Kokubo

Kim

Mishina

et al. 2014

SPI

View full text Add to dashboard Cite

show abstract

“…Spontaneous subdural spinal hematoma is a rare complication in patients on anticoagulant treatment with vitamin K antagonists,5, 6 heparins7 and DOACs 8, 9, 10, 11…”

Section: Introductionmentioning

confidence: 99%

Neurosurgery in a patient at peak levels of rivaroxaban: taking into account all factors

Vlieger

Dietvorst

Demaerel

et al. 2017

Research and Practice in Thrombosis and Haemostasis

View full text Add to dashboard Cite

Essentials There is scant data on surgery shortly after intake of rivaroxaban.We performed neurosurgery using high dose PCCs and tranexamic acid.Intraoperative haemostasis was good and no transfusion was needed.There was no delayed postoperative haemotoma or thromboembolic complication. We present a patient who underwent urgent neurosurgery for acute onset paraplegia due to a spontaneous subdural spinal hematoma less than 5 hours after she had taken rivaroxaban. The Key Clinical Question was whether early high‐risk surgery on a patient taking direct oral anticoagulants is feasible. Prothrombin complex concentrate (PCC) and tranexamic acid were administered and perioperative hemostasis was good. There is scant data on neurosurgical procedures performed within 12 hours after the intake of a direct oral anticoagulant. With the hemostatic support of high‐dose PCC, early surgery after administration of rivaroxaban seems feasible in case of an emergency indication, but should only be considered when delaying surgery is esteemed hazardous to the patient. More experience is needed to allow balancing risks and benefits of urgent vs delayed intervention and on the optimal hemostatic support in the absence of a specific antidote.

show abstract

Spinales chronisches subdurales Hämatom

Hagen¹,

Lensch²

2007

Radiologe

View full text Add to dashboard Cite

Compared with spinal epidural hematomas, spinal subdural hematomas are rare; chronic forms are even more uncommon. These hematomas are associated not only with lumbar puncture and spinal trauma, but also with coagulopathies, vascular malformations and tumors. Compression of the spinal cord and the cauda equina means that the patients develop increasing back or radicular pain, followed by paraparesis and bladder and bowel paralysis, so that in most cases surgical decompression is carried out. On magnetic resonance imaging these hematomas present as thoracic or lumbar subdural masses, their signal intensity varying with the age of the hematoma. We report the clinical course and the findings revealed by imaging that led to the diagnosis in three cases of chronic spinal subdural hematoma.

show abstract

Spinal Chronic Subdural Hematoma in Association With Anticoagulant Therapy

Abstract: SCSDH should be included in the differential diagnosis of progressive spinal cord and nerve root compression in patients receiving anticoagulant therapy. Prompt diagnosis and early surgical decompression lead to a good outcome.

Cited by 38 publications

References 29 publications

Prospective assessment of concomitant lumbar and chronic subdural hematoma: is migration from the intracranial space involved in their manifestation?

Prospective assessment of concomitant lumbar and chronic subdural hematoma: is migration from the intracranial space involved in their manifestation?

Neurosurgery in a patient at peak levels of rivaroxaban: taking into account all factors

Spinales chronisches subdurales Hämatom

Contact Info

Product

Resources

About