Spontaneous epidural hematoma of the spine associated with oral anticoagulants: 3 Case Studies

Tawk, Charbel; Moussa, Majd El Hajj; Zgheib, Raviella; Nohra, G.

doi:10.1016/j.ijscr.2015.05.022

Cited by 35 publications

(44 citation statements)

References 14 publications

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“…SSEHs often present with an abrupt onset of severe neck or back pain that can radiate into the extremities and commonly is followed by symptoms ranging from nerve root agitation to full neurologic impairment (1,(2)(3)(4)7,8). The symptoms typically are that of a lower motor neuron pathology with hyporeflexia and flaccid paralysis (1).…”

Section: Discussionmentioning

confidence: 99%

“…However, a meta-analysis has suggested no increased risk of SSEHs in individuals with hypertension (4). Some have reported upwards of 17-30% of all SSEHs are linked to anticoagulant use (5,8). Others have listed minor trauma, pregnancy, hemophilia, and leukemia as associated causes of SSEH (5,7).…”

Section: Discussionmentioning

confidence: 99%

“…When a SSEH is suspected, the imaging modality of choice is an MRI (7)(8)(9). When compared to the spinal cord within 24 h from symptom onset, the hematoma typically appears isointense on T1-weighted and hyperintense on T2-weighted MRI imaging (1,5,7).…”

Section: A B Cmentioning

confidence: 99%

“…Chronic hematomas become hypointense on both T1-and T2-weighted images (1). Fat suppression images may be used to distinguish hematoma from epidural fat (8). Sometimes active bleeding into the hematoma will reveal a central area of enhancement when contrast is used (8).…”

Section: A B Cmentioning

confidence: 99%

“…Fat suppression images may be used to distinguish hematoma from epidural fat (8). Sometimes active bleeding into the hematoma will reveal a central area of enhancement when contrast is used (8). Some authors have noted that occasionally an epidural hematoma will exhibit enhancement, which can be due to hyperemia of the dura or hypertrophic meninges (5,8).…”

Section: A B Cmentioning

confidence: 99%

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Spontaneous spinal epidural hematoma: literature review

2017

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Review the current literature regarding spontaneous spinal epidural hematomas (SSEHs) and report on the known risk factors, evaluation, and treatment of this rare entity. A literature search was performed using PubMed and Ovid to identify articles pertaining to SSEHs. Due to the rarity of the pathologic entity, only scattered case reports and associated reviews are available. SSEHs are a rare yet potentially life-altering event. The underlying risk factors are poorly understood, and SSEHs present with minimal or no antecedent trauma. SSEHs warrant urgent surgical intervention given the associated risk of permanent neurologic sequelae. Given the potential for persistent neurologic deficits, physicians must entertain a clinical suspicion of SSEH when a patient presents with a history of back pain followed by neurologic deficits. Even without clear risk factors for hemorrhage, the appropriate evaluation to include advanced imaging studies should be obtained to allow for identification of this entity and urgent surgical management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: A B Cmentioning

confidence: 99%

Section: A B Cmentioning

confidence: 99%

Section: A B Cmentioning

confidence: 99%

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Spontaneous spinal epidural hematoma: literature review

2017

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Spontaneous spinal epidural hematoma in a patient on acenocoumarol for valvular atrial fibrillation: A rare case report

El-Azrak

Noumairi

Oulalite

et al. 2021

Annals of Medicine and Surgery

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Introduction Spontaneous spinal epidural hematoma (SSEH) is a rare finding, but one with serious clinical implications. Oral anticoagulant drugs are known to be associated with the SSEH onset, particularly when combined with drugs increasing the bleeding risk. Case presentation We present the case of a 62-year-old female on acencoumarol for her atrial fibrillation complicating severe mitral stenosis with a history of Ketoprofen use for the onset of her first symptoms. She presented to our emergency room with paraplegia and sphincter disturbance. Spinal magnetic resonance imaging (MRI) revealed a posterior SSEH extended from T10 to T12 requiring an urgent decompression of the spinal cord by laminectomy performed within 48 hours from the symptom's onset. After 3 months of rehabilitation, the patient improves partially her muscular strength with mostly unchanged sensitive and sphincteric levels. Clinical discussion Vitamin K antagonists (VKA) use appears to be a high suspicion index for SSEH diagnosis resulting in earlier surgery and improving neurological outcome. Also, it is important to pay attention to the concomitant use of VKA and non-steroidal anti-inflammatory drugs which increase the risk of bleeding and may worsen the neurological outcome. Conclusion SSEH is a rare and serious finding which should be especially searched when a history of oral anticoagulation is reported in presence of neurological symptoms. A prompt and suitable management may improve the patient outcomes.

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A retrospective analysis of 30 patients with spontaneous spinal epidural hematoma

Nitta

Imamura

Miyama

et al. 2021

Interdisciplinary Neurosurgery

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Spontaneous epidural hematoma of the spine associated with oral anticoagulants: 3 Case Studies

Abstract: HighlightsSpontaneous epidural hematoma of the spine (SEHS) is an extremely rare entity.Early diagnosis and treatment showed to have the best outcome.SESH should be suspected in every acute medullary syndrome with spinal pain, motor and/or sensory deficit.

Cited by 35 publications

References 14 publications

Spontaneous spinal epidural hematoma: literature review

Spontaneous spinal epidural hematoma: literature review

Spontaneous spinal epidural hematoma in a patient on acenocoumarol for valvular atrial fibrillation: A rare case report

A retrospective analysis of 30 patients with spontaneous spinal epidural hematoma

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