Spontaneous Spinal Epidural Hematoma Associated With the Use of Low-dose Aspirin in Elderly Patient

Phang, Zi Hao; Chew, Jun Jie; Jayamalar, A; Thurairajasingam, P; Ibrahim, Saadon

doi:10.5435/jaaosglobal-d-18-00059

Cited by 9 publications

(16 citation statements)

References 7 publications

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“…[ 7 ] Long-term aspirin use has also been associated with SSEH in prior case series. [ 4 , 12 , 14 ] Of note, both patients presented here had long-term exposure to aspirin, and the SSEH described in Case 2 was likely pharmacologically associated.…”

Section: Discussionmentioning

confidence: 86%

Spontaneous cervical epidural hematoma: Insight into this occurrence with case examples

Jarrah

Fiani²,

Runnels

2021

Surgical Neurology International

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Background: First characterized in the 19th century, spontaneous spinal epidural hematoma (SSEH) is known as the idiopathic accumulation of blood within the spinal canal’s epidural space, causing symptoms varying from general back pain to complete paraplegia. With varying etiologies, a broad spectrum of severity and symptoms, a time-dependent resolution period, and no documented diagnosis or treatment algorithm, SSEH is a commonly misunderstood condition associated with increasing morbidity. While SSEH can occur at any vertebrae level, 16% of all SSEH cases occur in the cervical spine, making it a region of interest to clinicians. Case Description: Herein, the authors present two case examples describing the clinical presentation of SSEH, while also reviewing the literature to provide a comprehensive overview of its presentation, pathology, and treatment. The first case is a patient with nontraumatic sudden onset neck pain with rapidly progressing weakness. The second case is a patient with painless weakness that developed while taking 325 mg of aspirin daily. Conclusion: Clinicians should keep SSEH in their differential diagnosis when seeing patients with nontraumatic sources of weakness in their extremities. The appropriate steps should be followed to diagnose and treat this condition with magnetic resonance imaging and surgical decompression if there are progressive neurological deficits. There is a continued need for more extensive database-driven studies to understand better SSEHs clinical presentation, etiology, and ultimate treatment.

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Section: Discussionmentioning

confidence: 86%

Spontaneous cervical epidural hematoma: Insight into this occurrence with case examples

Jarrah

Fiani²,

Runnels

2021

Surgical Neurology International

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“…12 The occurrence of SSEH has been associated with several conditions, such as hemodialysis, thrombolysis, or antiplatelet-anticoagulant therapy including aspirin, dabigatran, and rivaroxaban. [13][14][15][16] MRI appears to be the gold standard imaging modality for diagnosis. Surgery and, more specifically, urgent decompressive laminectomy and evacuation of hematoma is indicated in several cases; however, it can occasionally be deferred if the patient demonstrates significant and rapid improvement.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Epidural Hematoma of the Cervical Spine Following Thrombolysis in a Patient with STEMI—Two Medical Specialties Facing a Rare Dilemma

Tsarouchas

Mouselimis

Bakogiannis

et al. 2019

JNRP

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Spontaneous spinal epidural hematoma (SSEH) is a rare, albeit well-documented complication following thrombolysis treatment in ST elevation myocardial infarction (STEMI). A SSEH usually manifests with cervical pain and neurologic deficits and may require surgical intervention. In this case report, we present the first reported SSEH to occur following thrombolysis with reteplase. In this case, the SSEH manifested with cervical pain shortly after the patient emerged from his rescue percutaneous coronary intervention (PCI). Although magnetic resonance imaging reported spinal cord compression, the lack of neurologic symptoms prompted the treating clinicians to delay surgery. A dangerous dilemma emerged, as the usual antithrombotic regimen that was necessary to avoid stent thrombosis post-PCI, was also likely to exacerbate the bleeding. As a compromise, the patient only received aspirin as a single antiplatelet therapy. Ultimately, the patient responded well to conservative treatment, with the hematoma stabilizing a week later, without residual neurologic deficits. In conclusion, the conservative treatment of SSEH appears to be an acceptable option for carefully selected patients, but the risks of permanent neurologic deficits and stent thrombosis have to be weighted for each patient.

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“…To date, there are no clear guidelines in regard to the most appropriate time to restart antiplatelet therapy after surgical intervention in cases of spontaneous SEDH [ 8 ]. In our case, we restarted aspirin and clopidogrel on the first postoperative day after consulting our cardiologist, who recommended obtaining an ECG and cardiac enzymes analysis every eight hours for 24 hours postoperatively.…”

Section: Case Presentationmentioning

confidence: 99%

“…Antithrombotic medications are nowadays widely prescribed. A rare yet critical association linked with their use is spontaneous SEDH [4,[6][7][8]. Antithrombotic agents described in the literature to be implicated in spontaneous SEDH are aspirin, clopidogrel, and ticlopidine [8].…”

Section: Introductionmentioning

confidence: 99%

“…A rare yet critical association linked with their use is spontaneous SEDH [ 4 , 6 - 8 ]. Antithrombotic agents described in the literature to be implicated in spontaneous SEDH are aspirin, clopidogrel, and ticlopidine [ 8 ]. Here, we report a case of spontaneous SEDH in a female patient on short-term dual antiplatelet therapy with aspirin and clopidogrel.…”

Section: Introductionmentioning

confidence: 99%

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Spontaneous Spinal Epidural Hematoma Associated With Short-Term Dual Antiplatelet Therapy: A Case Report

Alahmadi¹,

Almolky²,

Rezai³

2022

Cureus

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Spinal epidural hematoma (SEDH), either spontaneous or traumatic, is a rare neurosurgical emergency. Typically, the natural history is a sudden onset of severe neck or back pain, associated with neurological deficit, either immediately or after a short period of the pain onset. MRI is the gold standard investigation. The mainstay of treatment is spinal decompression, in the form of laminectomy or hemilaminectomy, with the evacuation of the hematoma. The occurrence of SEDH has been strongly associated with coagulopathy, especially that induced by anticoagulant use. The association between SEDH and antiplatelet therapy has been scarcely reported in the literature. We report a case of spontaneous SEDH in a patient who was on dual antiplatelet therapy. Our case is unique because the patient had been using antiplatelet agents for only six weeks prior to this diagnosis. As antiplatelet agents are widely prescribed, physicians should be able to anticipate SEDH as a possible complication of dual antiplatelet therapy to facilitate early treatment and better outcomes.

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Spontaneous Spinal Epidural Hematoma Associated With the Use of Low-dose Aspirin in Elderly Patient

Cited by 9 publications

References 7 publications

Spontaneous cervical epidural hematoma: Insight into this occurrence with case examples

Spontaneous cervical epidural hematoma: Insight into this occurrence with case examples

Spontaneous Epidural Hematoma of the Cervical Spine Following Thrombolysis in a Patient with STEMI—Two Medical Specialties Facing a Rare Dilemma

Spontaneous Spinal Epidural Hematoma Associated With Short-Term Dual Antiplatelet Therapy: A Case Report

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