J Korean Soc Spine Surg.  2004 Jun;11(2):125-129. 10.4184/jkss.2004.11.2.125.

Spontaneous Thoracic Spinal Epidural Hematoma after Use of Anticoagulant

• Park HJ
• Jeon JS

• KMID: 2097820
• DOI: http://doi.org/10.4184/jkss.2004.11.2.125

Abstract

A spinal epidural hemorrhage, secondary to thrombolytic and anticoagulative therapies, is becoming increasingly common. Urgent surgical decompression is generally warranted to preserve the neurological function. This case report describes an epidural hematoma, with neurological sequelae, in an elderly patient who received intravenous heparin therapy for about 48hrs due to unstable angina. The posterior decompression was urgently treated, but the neurological changes did not recover. The magnetic resonance imaging and operative findings are presented, along with a discussion of the anatomical and pathophysiological considerations that could lead to such a condition.

Keyword

Thoracic spine; Epidural hematoma; Anticoagulant

MeSH Terms

Aged
Angina, Unstable
Decompression
Decompression, Surgical
Hematoma
Hematoma, Epidural, Spinal*
Heparin
Humans
Magnetic Resonance Imaging
Heparin

Figure

• 

  Fig. 1. (A) Noncontrast T1-weighted sagittal magnetic resonance imaging of the thoracic spine shows a posterior epidural intermediate signal intensity at T8-L1 with mild effacement of the cord. (B) Noncontrast T2-weighted sagittal MRI shows the same epidural collection as slightly tubular high signal intensity, suggesting subacute blood. The scan also demonstrates marked signal intensity within the adjacent cord consistent with edema.

• 

  Fig. 2. Noncontrast sagittal scan demonstrates the epidural clot has completely resolved, but remained signal change within the cord 10 days after onset of hemorrhages.

Reference

1). Jackson R. Case of spinal apoplexy, Lancet. 1869; 2:5–6. (cited from Locke GE, Giorgio AJ, Biggers SL, Johnson AP, Salem F: Acute spinal epidural hematoma secondary to aspirin-induced prolonged bleeding. Surg Neurol 1976;5: 293-296.

2). Cintron GB. Spinal epidural hematoma causing cord compression after tissue plasminogen activator and heparin therapy. South Med J. 1991; 84:670–671.

3). Groen RJM, Ponssen H. The spontaneous spinal epidural hematoma. A study of the etiology. J Neurol Sci. 1990; 98:121–138.

4). Ohhata K, Tsujikawa S, et al. A case of spontaneous spinal epidural hematoma presenting Brown-Sequard syndrome. No Shinkei Geka. 1984; 12:1195–1200. (cited from Kato S, Seki H, Koshu K: Acute cervical spinal epidural hematoma with spontaneous resolution. Case report. Neurol Med Chir 1994;34: 23-26).

5). Phillips TW, Kling TF Jr, McGillicuddy JE. S ponta -neous ventral spinal epidural hematoma with anterior cord syndrome: report of case. Neurosurgry. 1981; 9:440–443.

6). Harik SI, Raichle ME, Reis DJ. Spontaneously remitting spinal epidural hematoma in a patient on anticoagulants. New Engl J Med. 1971; 284:1355–1357.

7). Kato S, Seki H, Koshu K. Acute cervical spinal epidural hematoma with spontaneous resolution. Case report. Neurol Med Chir. 1994; 34:23–26.

8). Locke G, Giorgio AJ, Biggers SI, Johnson AP, Salem F. Acute spinal epidural hematoma secondary to aspirin-induced prolonged bleeding. Surg Neurol. 1976; 5:293–296.

9). Mustafa MH, Gallino R. Spontaneous spinal epidural hematoma causing cord compression after streptokinase and heparin therapy for acute coronary artery occu lusion. South Med J. 1988; 81:1202–1203.

10). Rebello MD, Dastur HM. Spinal epidural hemorrhage: A review and two case reports. Neurol India. 1966; 14:135–145.

11). McQuarrie IG. Recovery from paraplegia caused by spontaneous spinal epidural hematoma. Neurology. 1978; 28:224–228.