Successful Recovery from Spontaneous Spinal Epidural Hematoma in a Patient Undergoing Hemodialysis

Abstract

Patient: Male, 70Final Diagnosis: Spontaneous spinal epidural hematomaSymptoms: Abdominal pain • chest pain • complete paraplegiaMedication: —Clinical Procedure: Conservative managementSpecialty: NephrologyObjective:Unusual clinical courseBackground:Spontaneous spinal epidural hematoma (SSEH) occurs in the spinal epidural space in the absence of traumatic or iatrogenic causes, and is considered to be a neurological emergency, as spinal cord compression may lead to neurological deficit. Prompt diagnosis of SSEH can be difficult due to the variety of presenting symptoms, which may resemble those of stroke. Patients who undergo hemodialysis (HD) are at risk of bleeding due to anticoagulation during dialysis and uremia. However, SSEH in HD patients undergoing HD has rarely been reported.Case Report:A 70-year-old Japanese man, who has been undergoing maintenance HD for the previous three years, was admitted to Kariya Toyota General Hospital, Aichi, Japan, with acute chest and abdominal pain, and with complete paraplegia. The patient denied any recent trauma or medical procedures. Magnetic resonance imaging showed an extensive hematoma in the thoracic and lumbar epidural space, extending from T8 to L5. The patient’s symptoms improved within three hours following hospital admission, and after three days without HD treatment, the SSEH decreased in size, and the patient successfully recovered without residual neurological deficits and without requiring surgery.Conclusions:The management of SSEH in patients undergoing HD can be difficult, due to anticoagulation during dialysis and uremia. Prompt diagnosis and close neurological monitoring are important for appropriate management. In patients whose symptoms improve within a short period, conservative management may be considered.

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

“…4 The degree of neurologic deficit and the time of improvement seem to be crucial factors for conservative treatment selection. 4,13 In our case, the fear of a hematoma recurrence led to the clinician recommending only the minimum of DAPT. There is no current consensus on how such a major bleeding event should influence short-and long-term antithrombotic strategy, so such a clinical judgment is required.…”

“…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.…”

“…4 Hibi et al also reported successful recovery after conservative treatment in a patient with SSEH following hemodialysis. 13 Although one case where the resolution of an SSEH in STEMI patient was achieved conservatively shouldn't change a clinician's approach to this clinical entity, it serves as a proof of concept that conservative management of such cases can help MI patients to avoid major surgery. As mentioned before, there is recent evidence that conservative treatment in the general SSEH population can be beneficial in selected patients.…”

Spontaneous Spinal Epidural Hematoma Complicated by Pulmonary Embolism During Pregnancy: A Case Report

“…Spontaneous spinal epidural hematoma (SSEH) is a rare condition, defined as a hematoma that occurs in the spinal epidural space without any precipitating factors (1). The usual clinical presentation includes sudden neck or back pain that progresses to paraparesis or quadriparesis, depending on the site of the lesion (2).…”