Spontaneous subdural hematoma of the thoracolumbar region with massive recurrent bleed

Cincu, Rafael; Lorente, Francisco de Asis; Rivero, David Sánchez; Eiras, J. A.; Ara, J.R.

doi:10.4103/0019-5413.49383

Cited by 9 publications

(4 citation statements)

References 19 publications

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“…A hypothesis is the occurrence of bleeding from a subarachnoid blood vessel, which extended to the intradural space. 6,[14][15][16][17] Furthermore, studies indicate that an increase of intrathoracic or intra-abdominal pressure (surgery in prone position) can increase pressure on spinal and root blood vessels. [15][16][17][18] In this case, treatment consisted of lumbar laminectomy from L1 to L4, durotomy, and evacuation of the hematoma to relieve pressure.…”

Section: Discussionmentioning

confidence: 99%

An Acute Spinal Intradural Hematoma after an Extraforaminal Wiltse Approach: A Case Report and Review of the Literature

Raymaekers

Beck

Goebel

et al. 2020

J Neurol Surg A Cent Eur Neurosurg

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A nontraumatic spontaneous spinal acute subdural hematoma (sSDH) is a rare complication after spinal surgery. Although an sSDH is often associated with anticoagulation therapy, vascular malformations, or lumbar puncture, the pathogenesis of nontraumatic spontaneous sSDH remains unclear. We present the case of an intradural hematoma after an extraforaminal surgery through the Wiltse approach for an extraforaminal disk herniation at L5/S1. This 58-year-old woman experienced hypoesthesia and progressive motor dysfunction in the left leg several hours postoperation. Urgent magnetic resonance imaging revealed an intradural hematoma at the L1/L2 to L2/L3 level in the ventral dural sac proximal to the surgical level. Surgical decompression was performed. There was no evidence of trauma, coagulopathy, or anticoagulation therapy. To our knowledge, this case is the first to report an acute sSDH proximal to the surgery level after an extraforaminal spinal surgery through the Wiltse approach for an extraforaminal disk herniation. It illustrates that attentive postoperative neurologic monitoring, even in the absence of intraoperative irregularities, remains important to diagnose and treat this complication at the early stage.

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Section: Discussionmentioning

confidence: 99%

An Acute Spinal Intradural Hematoma after an Extraforaminal Wiltse Approach: A Case Report and Review of the Literature

Raymaekers

Beck

Goebel

et al. 2020

J Neurol Surg A Cent Eur Neurosurg

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“…[ 2 10 ] The spontaneous variety is associated with risk factors like abnormalities of coagulation (due to antithrombotics, thrombolytics or conditions like hemophilia); with normal coagulation parameters but platelet dysfunction like in polycythemia; soft tissue trauma, lumbar puncture, underlying neoplasm, conditions causing raised intravascular pressure (such as sneezing, lifting weights, pregnancy, Valsalva maneuvre) and conditions with certain vascular pathologies like spinal vascular malformations, vasculitis or Paget's disease. [ 2 11 12 ] The final common endpoint pathology is bleeding from the valveless epidural veins. The chronic variety is rare and usually located in the lumbar area.…”

Section: Discussionmentioning

confidence: 99%

Drug interaction as cause of spontaneously resolving epidural spinal hematoma on warfarin therapy

Sagar¹,

Hassan²

2010

Journal of Neurosciences in Rural Practice

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We present a case of a 42-year-old male, an old case of deep vein thrombosis on warfarin and other drugs like quetiapine, aspirin, diclofenac sodium, fenofibrate, atorvastatin, propanolol and citalopram for concurrent illnesses, who presented with widespread mucocutaneous bleeding and epidural spinal hematoma. The epidural bleed presented clinically as a nontraumatic, rapidly improving myeloradiculopathy. Magnetic resonance imaging (MRI) of the spine revealed an epidural hematoma at D12-L1 level. The case was managed conservatively due lack of neurosurgical facilities. The patient gained full neurological recovery on conservative management alone. This case highlights the problem of drug interaction on warfarin therapy and also an unusual spontaneous recovery of spinal hematoma. Our case was anticoagulated in the recommended therapeutic INR range of 2.2 to 2.4. Most of the similar cases reported in literature were also anticoagulated in the therapeutic range. Thus intraspinal hemorrhage is a rare but dangerous complication of anticoagulant therapy. It must be suspected in any patient on anticoagulant agents who complains of local or referred spinal pain associated with neurological deficits. Drug interactions with warfarin are common. High suspicion and immediate intervention are essential to prevent complications from intraspinal hemorrhage.

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“…In our patient there was no risk factor as described earlier except that she was on anticoagulant. The patient denied any history of trauma, acupuncture, bleeding diathesis so that we could not help suspecting anticoagulation therapy as a cause of hematoma [5][6][7].…”

Section: Case Reportmentioning

confidence: 99%

Sudden Hemiplegia by Epidural Hematoma in a Patient Treated with Warfarin and Therapeutic Range International Normalized Ratio

Seo

Park

Lee

et al. 2015

Soonchunhyang Med Sci

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Spontaneous spinal epidural hematoma is extremely rare. It can cause fatal complication such as permanent neurologic deficit. Even though the exact cause of epidural hematoma is not known in most cases, anticoagulation treatment is associated in some cases. In this situation, prompt reversal of anticoagulation and immediate decompression surgery is required. Seventy-year-old woman presesnted with sudden hemiplegia. She had history of hypertension, dyslipidemia, and paroxysmal atrial fibrillation and had taken antihypertensive agent, statin, and warfarin. She did not have any history of trauma and her international normalized ratio was within therapeutic range during follow-up and at the time of event. Physical examination revealed decreased right extremities' motor and sensory function but cognitive function was normal. Detailed neurologic examination and spinal magnetic resonance imaging identified extensive, spontaneous spinal epidural hematoma. After the reversal of anticoagulation with vitamin K injection, the patient underwent emergent hematoma removal surgery and recovered completely. Our case suggests epidural hematoma should be considered in sudden hemiplegia patients with anticoagulation therapy. Immediate reversal of anticoagulation and decompression surgery can avoid neurologic deficit.

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Spontaneous subdural hematoma of the thoracolumbar region with massive recurrent bleed

Cited by 9 publications

References 19 publications

An Acute Spinal Intradural Hematoma after an Extraforaminal Wiltse Approach: A Case Report and Review of the Literature

An Acute Spinal Intradural Hematoma after an Extraforaminal Wiltse Approach: A Case Report and Review of the Literature

Drug interaction as cause of spontaneously resolving epidural spinal hematoma on warfarin therapy

Sudden Hemiplegia by Epidural Hematoma in a Patient Treated with Warfarin and Therapeutic Range International Normalized Ratio

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