Korean Circ J.  2011 Dec;41(12):759-762. 10.4070/kcj.2011.41.12.759.

Spontaneous Spinal Epidural Hematomas Associated With Acute Myocardial Infarction Treatment

• Yang SM
• Kang SH
• Kim KT
• Park SW
• Lee WS

• KMID: 1776254
• DOI: http://doi.org/10.4070/kcj.2011.41.12.759

Abstract

Many studies have reported spontaneous spinal epidural hematoma (SSEH). Although most cases are idiopathic, several are associated with thrombolytic therapy or anticoagulants. We report a case of SSEH coincident with acute myocardial infarction (AMI), which caused serious neurological deficits. A 56 year old man presented with chest pain accompanied with back and neck pain, which was regarded as an atypical symptom of AMI. He was treated with nitroglycerin, aspirin, low molecular weight heparin, and clopidogrel. A spinal magnetic resonance image taken after paraplegia developed 3 days after the initial symptoms revealed an epidural hematoma at the cervical and thoracolumbar spine. Despite emergent decompressive surgery, paraplegia has not improved 7 months after surgery. A SSEH should be considered when patients complain of abrupt, strong, and non-traumatic back and neck pain, particularly if they have no spinal pain history.

Keyword

Acute myocardial infarction; Hematoma, epidural, spinal; Paraplegia; Thrombolytic therapy; Anticoagulants

MeSH Terms

Anticoagulants
Aspirin
Chest Pain
Hematoma
Hematoma, Epidural, Spinal
Heparin, Low-Molecular-Weight
Humans
Magnetic Resonance Spectroscopy
Myocardial Infarction
Neck Pain
Nitroglycerin
Paraplegia
Spine
Thrombolytic Therapy
Ticlopidine
Anticoagulants
Aspirin
Heparin, Low-Molecular-Weight
Nitroglycerin
Ticlopidine

Figure

• 

  Fig. 1 T2 weighted sagittal cervical magnetic resonance images. A: lentiform heterogeneous mass (arrows) located in the ventral epidural space from C2 to 3 compressed the cervical cord. B: T2 weighted spinal sagittal MRI. Heterogeneous mass (arrows) from T7 to L1 compressed the spinal cord. Abnormally high signal intensity of the spinal cord at the thoracolumbar junction indicated a spinal cord injury. C: T2 weighted axial section at the thoracolumbar junction revealed a spinal hematoma (arrows) in front of the spinal cord. Some high-signal intensity hematomas indicate multistage hemorrhages.

• 

  Fig. 2 T2 weighted whole-spine sagittal magnetic resonance image obtained 2 months after surgery. No residual hematoma was evident. However, multiple abnormal high signal intensities (arrows) indicated spinal cord atrophy after the cord injury.

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