Spontaneous spinal extradural hematoma during pregnancy

Carroll, Stephen; Malhotra, Ruchika; Eustace, D.; Sharr, M. M.; Morcos, S. F.

doi:10.1002/(sici)1520-6661(199707/08)6:4<218::aid-mfm6>3.0.co;2-m

Cited by 31 publications

(29 citation statements)

References 6 publications

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“…Haemorrhagic disorders such as hematoma were originally believed to not develop easily during pregnancy because blood coagulability is increased in pregnant women [1]. Because of its rarity and atypical symptoms, its prompt diagnosis is difficult and its aetiology remains unclear.…”

Section: Discussionmentioning

confidence: 74%

Non Traumatic Spinal Epidural Haematoma in a Woman with HELLP Syndrome: A Case Report

Bansal

Maheshwarappa

Gupta

et al. 2014

JCDR

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A 30-year-old pregnant female with 36 wk of gestation presented to the Department of Obstetrics with sudden onset of paraplegia and back pain. 12 h before her admission the patient experienced sudden onset of severe neck pain and progressive weakness in extremities along with sensory loss in her legs and torso which was not associated with any physical activity. She was on iron and vitamin supplementation. Her past medical history was unremarkable.On admission, the patient's neurological examination was remarkable for weakness in lower extremities. The patient had sensory loss in her lower extremities. On hematological testing, her platelet count was markedly reduced to 1.5 × 104 cells/μL. Liver function impairment was also detected (glutamic-oxaloacetic transaminase, 645U/L; glutamic-pyruvic transaminase, 284U/L; total bilirubin, 8.6 mg), while her lactate dehydrogenase and cytokeratin levels were elevated. HELLP syndrome was diagnosed based on the above laboratory test findings.An emergency MRI scan was performed to assess her bilateral lower limb paralysis. Two space-occupying lesions were detected in her spinal canal, one in her lower cervical and second one in her upper thoracic level . The lesions were diagnosed as epidural hematomas based on the MRI findings at this time. Emergency caesarean section was performed to bring the pregnancy to an end on the same day. Later emergency decompression was performed and the diagnosis of epidural haematomas was confirmed. The weakness of her lower limbs improved gradually over few months. The patient was followed up for two years. No recurrence or residual weakness was found. Radiology SectionNon Traumatic Spinal Epidural Haematoma in a Woman with HELLP Syndrome: A Case Report aBstRaCt Spinal epidural haematomas (SEH) is a potentially reversible cause of spinal cord and nerve root compression which needs prompt surgical decompression for satisfactory neurological recovery. SEH occurs very rarely in pregnant woman with HELLP syndrome (hemolysis, elevated liver enzyme levels, and low platelet levels). Most of the SEH cases reported in HELLP syndrome in the literature are due to iatrogenic interventions. We report a still rarer case of non traumatic spinal epidural haematoma in a pregnant woman with HELLP Syndrome. DisCussionSpinal epidural hematoma (SEH) associated with pregnancy is a rare cause of spinal cord compression and spontaneous spinal epidural hematoma (SSEH) associated with pregnancy is even more uncommon. Haemorrhagic disorders such as hematoma were originally believed to not develop easily during pregnancy because blood coagulability is increased in pregnant women [1]. Because of its rarity and atypical symptoms, its prompt diagnosis is difficult and its aetiology remains unclear. There were few studies discussing the aetiology, presentation and treatment of spontaneous spinal epidural hematoma (SSEH) during pregnancy where the clotting profile was normal. There have only been nine previously published cases of SSEH occurring during pregnancy [1][2][3]. H...

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Section: Discussionmentioning

confidence: 74%

Non Traumatic Spinal Epidural Haematoma in a Woman with HELLP Syndrome: A Case Report

Bansal

Maheshwarappa

Gupta

et al. 2014

JCDR

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“…It could be that the combination of these factors increased her risk for developing SSEH and could also explain the multiple epidural and subdural hematomas on various levels of the spinal canal, in contrast to the single SSEH in previously reported cases (1-3). She developed SSEH characterized by the usual clinical symptoms, but this occurred postpartum and not, as previously reported, during pregnancy (1)(2)(3). No surgical decompression was conducted because of the surgical risk incurred by low platelet count and hematomas on several levels from C2 to T8.…”

Section: Case Reportmentioning

confidence: 75%

“…The hypothesis for the pathogenesis of SSEH is rupture of epidural veins situated in the low-pressure epidural space secondary to sudden increases in intra-abdominal or intrathoracic pressure; this is usually associated with bleeding disorders (4). The etiology of SSEH during pregnancy (a state of hypercoagulability) remains unclear (1). The changes in hemodynamics during pregnancy may increase epidural venous pressure and cause rupture and hemorrhage (1,2).…”

Section: Case Reportmentioning

confidence: 99%

“…The etiology of SSEH during pregnancy (a state of hypercoagulability) remains unclear (1). The changes in hemodynamics during pregnancy may increase epidural venous pressure and cause rupture and hemorrhage (1,2).…”

Section: Case Reportmentioning

confidence: 99%

“…There have only been 9 previously published cases of SSEH occurring during pregnancy (1)(2)(3). We present what we believe is the first reported case of SSEH associated with hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome occurring directly postpartum.…”

Section: Introductionmentioning

confidence: 99%

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Postpartum Spinal Cord Injury in a Woman With HELLP Syndrome

Kuppevelt

2008

The Journal of Spinal Cord Medicine

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Objective: To report a rare cause of spinal cord injury. Study design: Case report. Case report: A 36-year-old woman presented with acute onset of paresis of the upper and lower extremity (level C5, ASIA B) the day after delivering a healthy daughter (39 weeks' gestation). Prior to giving birth, she was admitted with gestational hypertension. Directly postpartum, blood pressure increased markedly, and hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome was diagnosed. The next day, tetraplegia developed. Magnetic resonance imaging showed multiple epidural and subdural hematomas in the cervical and thoracic spinal canal extending from C2 to T8, with displacement and compression of the cord. Three weeks after treatment with intravenous labetalol, she made a significant recovery (level T1, ASIA D). Conclusions: This rare cause of spinal cord injury shows the importance of closely monitoring pregnant patients with hypertension complicated with HELLP syndrome both pre-and postpartum.

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Long term neurological sequelae of childbirth

Holdcroft¹

2000

Regional Analgesia in Obstetrics

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Spontaneous spinal extradural hematoma during pregnancy

Cited by 31 publications

References 6 publications

Non Traumatic Spinal Epidural Haematoma in a Woman with HELLP Syndrome: A Case Report

Non Traumatic Spinal Epidural Haematoma in a Woman with HELLP Syndrome: A Case Report

Postpartum Spinal Cord Injury in a Woman With HELLP Syndrome

Long term neurological sequelae of childbirth

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