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INTRODUCTION: Spinal epidural hematomas are a surgical emergency, the delay in diagnosis can develop devastating sequelae due to its acute and progressive course. If not treated properly, it may lead to death or permanent neurological deficit. It is a rare condition that can occur in patients with hematologic pathology. CASE PRESENTATION: We report a case report and literature review of a patient with antiphospholipid syndrome, who undergoes a diagnostic lumbar puncture for probable fungal meningitis. Developed a spinal acute epidural hematoma with neurological involvement that is evidenced in MRI. Urgent surgical decompression was performed with good results. DISCUSSION: Despite the low incidence of an epidural hematoma in patients who undergo lumbar puncture, it is important to perform a thorough evaluation in any patient with coagulation abnormalities prior and after a lumbar puncture, by reason of the inherent possibility of developing an epidural hematoma at the site of the procedure. In the same way, early diagnosis and aggressive treatment is necessary in patients who develop progressive neurological symptoms to limit the damage and improve the prognosis for neurological recovery.

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El hematoma epidural espontáneo es una entidad muy poco frecuente que supone una urgencia neurológica. Su presentación es muy variable, desde un dolor de espalda hasta una tetraplejia, según la gravedad y el nivel de compresión. Se comunica el caso de un paciente cardiópata de 71 años, tratado con acenocumarol, que presentó un hematoma epidural de modo espontáneo. Al inclinarse hacia el suelo, el paciente, que no tenía síntomas, sufrió un dolor brusco cervical seguido de debilidad en los miembros superiores e inferiores. Ante la sospecha clínica de una compresión medular, se decide realizar una resonancia magnética de urgencia, que mostró un hematoma de localización epidural con extensión desde C4 hasta T8. El diagnóstico urgente y el tratamiento de descompresión precoz son fundamentales para reducir al mínimo los daños neurológicos posteriores permanentes. Nivel de Evidencia: IV

Spontaneous spinal epidural hematoma is an uncommon condition and a neurological emergency. The clinical presentation of this type of hematoma is very variable, ranging from a backache up to a quadriplegia, according to the severity and the site of compression. Here, we discuss the clinical case of a 71-year-old patient with heart problems, under previous treatment with acenocumarol, that suffered a spontaneous epidural hematoma. The patient, previously asymptomatic, presented, sudden cervical pain when he bent over, followed by weakness in the lower and the upper limbs. Due to the clinical suspicion, an emergency MRI was performed, showing an epidural hematoma extending from C4 to T8. Early diagnosis and decompressive treatment are mandatory to minimize permanent neurological damage. Level of Evidence: IV

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Concomitant traumatic spinal cord and intracranial subdural hematomas associated with a retroclival hematoma are very uncommon. Their pathophysiology is not totally elucidated, but one hypothesis is the migration of the hematoma from the head to the spine. In the present case report, the authors describe the case of a 51-year-old man presenting with headache, nauseas and back pain after a head trauma who presented with intracranial and spinal cord subdural hematomas. Drainage was performed but, 1 week later, a retroclival subdural hematoma was diagnosed. The present paper discusses the pathophysiology, the clinical presentation, as well as the complications of concomitant traumatic spinal cord and intracranial subdural hematomas associated with a retroclival hematoma, and reviews this condition.

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Objective The present study is a case report of a 57-year-old female with controlled hypertension who presented with spontaneous spinal epidural hematoma (SSEH) mimicking a cerebrovascular accident (CVA) and was successfully treated by surgical decompression. Methods A 57-year-old woman with a medical history of hypertension presented with a sudden onset of weakness in the right upper and lower extremities. Weakness of grade 3/5 was noted in her right upper and lower extremities, but there was no motor weakness of the right facial muscles. A magnetic resonance imaging (MRI) exam of the cervical spine revealed an epidural hematoma extending from level C5 to level C7, causing spinal cord compression. Results During surgery, a cervical spinal epidural hematoma (SEH) was evacuated. Postoperatively, the power in both limbs improved to grade 5/5 just after surgery. Conclusions A high degree of suspicion, meticulous history taking, and physical examination have a great importance in these rare conditions because anticoagulant therapy as a routine treatment for ischemic CVA could be life-threatening.

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BACKGROUND: Spontaneous spinal epidural hematoma is a relatively rare but potentially disabling disease. Prompt timely surgical management may promote recovery even in severe cases. CASE PRESENTATION: We report a 34-year-old man with a 2-hour history of sudden severe back pain, followed by weakness and numbness over the bilateral lower limbs, progressing to intense paraparesis and anesthesia. A spinal magnetic resonance imaging scan was performed and revealed an anterior epidural hematoma of the thoracic spine. He underwent an emergency decompression laminectomy of the thoracic spine and hematoma evacuation. Just after surgery, his lower extremity movements improved. After 1 week, there was no residual weakness and ambulation without assistance was resumed, with residual paresthesia on the plantar face of both feet. After 5 months, no residual symptoms persisted. CONCLUSIONS: The diagnosis of spontaneous spinal epidural hematoma must be kept in mind in cases of sudden back pain with symptoms of spinal cord compression. Early recognition, accurate diagnosis and prompt surgical treatment may result in significant improvement even in severe cases.

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El hematoma espinal epidural espontáneo es raro en niños, especialmente en lactantes menores de un año. A esta edad, en la literatura inglesa se han reportado solamente cuatro casos. Considerando que en los lactantes los síntomas iniciales no son específicos, el diagnóstico se puede retrasar. Presentamos el primer caso reportado en Chile de un lactante con hematoma espinal epidural espontáneo. Un lactante varón de 11 meses de edad, inicia cuadro de repentino llanto, irritabilidad sostenida, con llanto al movilizar el cuello, agregándose cuatro días después, postura con leve inclinación de cabeza a izquierda, elevación de hombro izquierdo y paresia braquial derecha. Al 13°día desarrolla episodio repentino de distonía lingual, hipertonía de extremidades superiores y ataxia respiratoria. Al 16° día de evolución la RM demuestra una lesión epidural que comprime la médula espinal entre C2 y C5. Se realizó una laminectomía de emergencia extrayéndose el hematoma. Angio-RM y angio-TAC cervical fueron normales. Tres meses después de la cirugía, se mantiene con apoyo de ventilación mecánica y tetraparesia.

Spontaneous spinal epidural hematoma is rare in children, especially in infants less than one year old. Only four cases in this age range have been reported in the english literature Because of non-specific presenting symptoms in infants, the diagnosis may be delayed. We report the first case of spontaneous spinal epidural hematoma in Chile. An eleven month-old boy initially presented with sudden weeping, irritability and crying in response to neck mobilization. Four days later he developed head lateralization and upper right limb motor weakness. On the 13th day he had a sudden episode of lingual dystonia, upper limb hypertonia and respiratory ataxia. MRI showed epidural mass compressing the spinal cord at C2 to C5 level. At 16th day of evolution an emergency laminectomy and evacuation of hematoma was done. Cervical Angio-MRI and Angio-CT scan were normal. Three months after surgery, he is still tetraparetic and requires ventilatory support.

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Spontaneous spinal epidural hematoma (SSEH) is a rare entity. We report a case of thoracolumbar SSEH in a 69 years-old woman, that occurred in 2005 without an etiologic factor to justify it. She recovered ad integrum after surgical decompressive treatment. We reviewed and discussed etiology, presentation, diagnostic approaches, and treatment.

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O hematoma extradural espinhal espontâneo é considerado raro. Tem sido associado com hipertensão arterial e coagulopatias. O exame de escolha para diagnóstico é a ressonância nuclear magnética.O tratamento de escolha é drenagem cirúrgica do hematoma. O prognóstico está relacionado com a etiologia, intervalo entre icto e diagnóstico e o grau de déficits neurológicos. Os autores relatam um caso de hematoma extradural espinhal espontâneo, localizado na região torácica, com quadro de choque medular, sendo submetido a tratamento cirúrgico, que evoluiu para óbito.

The spontaneous spinal extradural hematoma is rare. It has been associated with arterial hypertension and coagulopaties. Magnetic resonance is the first choice for neuroimaging diagnosis. The surgical drainage of the hematoma is the best treatment. Prognosis is related to etiology, interval between ictus and diagnosis and degree of neurological deficits. The authors report a case of spontaneous spinal extradural hematoma, located in thoracic region, with medullar shock syndrome, that was submitted tosurgical treatment but died for non neurological complications.

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