Spinal epidural hematoma in antiphospholipid syndrome: case report and review of the literature

Abstract

Spinal epidural hematomas are a surgical emergency, the delay in diagnosis can develop devastating sequelae due to its acute and progressive course. If not treated properly, it may lead to death or permanent neurological deficit. It is a rare condition that can occur in patients with hematologic pathology. CASE PRESENTATION: We report a case report and literature review of a patient with antiphospholipid syndrome, who undergoes a diagnostic lumbar puncture for probable fungal meningitis. Developed a spinal acute epidural hematoma with neurological involvement that is evidenced in MRI. Urgent surgical decompression was performed with good results. DISCUSSION: Despite the low incidence of an epidural hematoma in patients who undergo lumbar puncture, it is important to perform a thorough evaluation in any patient with coagulation abnormalities prior and after a lumbar puncture, by reason of the inherent possibility of developing an epidural hematoma at the site of the procedure. In the same way, early diagnosis and aggressive treatment is necessary in patients who develop progressive neurological symptoms to limit the damage and improve the prognosis for neurological recovery.

Spinal Ultrasound: A Safe and Valuable, but Underutilized Imaging Modality to Evaluate Epidural Hematomas in Infants

“…Common symptoms of symptomatic SEH include back pain, paresthesias, paresis, and urinary incontinence. 1,8,9 However, infants are more likely to present with less specific clinical features. Neurological deficits can be more difficult to recognize in these patients, potentially leading to delays in diagnosis.…”