Anesth Pain Med.  2017 Jul;12(3):266-270. 10.17085/apm.2017.12.3.266.

Drainage of an acute spinal epidural hematoma that developed without risk factors in the thoracic spine using epidural needle: A case report

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Inha University College of Medicine, Incheon, Korea. kbg95@nate.com

Abstract

Epidural hematoma after epidural block is a rare complication in healthy patients without risk factor. However, this rare disease can lead to neurological symptoms or paralysis. It is usually treated with surgical drainage. Herein we report a case of acute thoracic epidural hematoma associated with neurologic symptoms after epidural block in a healthy male without risk factors. We performed drainage of the epidural hematoma using 18-gauge Tuohy needle without surgical intervention. The patient's neurological symptoms and pain were relieved. He was discharged without sequelae.

Keyword

Epidural block; Epidural needle; Spinal epidural hematoma

MeSH Terms

Drainage*
Hematoma
Hematoma, Epidural, Spinal*
Humans
Male
Needles*
Neurologic Manifestations
Paralysis
Rare Diseases
Risk Factors*
Spine*

Figure

  • Fig. 1 Sagittal T2-weighted image. Acute epidural hematoma (white arrow) at posterior epidural space of T3 to T6 level with severe cord compression at T4-5-6 level.

  • Fig. 2 Transaxil T2-weighted image. Nodular enhancing foci (white arrow) is noted inside the epidural hematoma at the level of T5 (right side).

  • Fig. 3 Drainage of epidural hematoma with 18-gauge Tuohy needle.


Reference

1. Lee MH, Song JH, Lee DI, Ahn HS, Park JW, Cha YD. Newly developed urinary retention and motor weakness of lower extremities in a postherpetic neuralgia patient. Korean J Pain. 2013; 26:76–9. DOI: 10.3344/kjp.2013.26.1.76. PMID: 23342213. PMCID: PMC3546216.
2. Lee JS, Suh TK. Spontaneous lumbar spinal epidural hematoma without risk factor. J Korean Orthop Assoc. 2005; 40:1013–6.
3. Choe WJ, Choe JH, Kim JW. Epidural hematoma after epidural catheterization without coagulopathy. Korean J Anesthesiol. 2006; 50:221–3. DOI: 10.4097/kjae.2006.50.2.221.
4. Groen RJ. Non-operative treatment of spontaneous spinal epidural hematomas: a review of the literature and a comparison with operative cases. Acta Neurochir (Wien). 2004; 146:103–10. DOI: 10.1007/s00701-003-0160-9. PMID: 14963742.
5. Li SL, Wang DX, Ma D. Epidural hematoma after neuraxial blockade: a retrospective report from China. Anesth Analg. 2010; 111:1322–4. DOI: 10.1213/ANE.0b013e3181f1b9ea. PMID: 20705781.
6. Vandermeulen EP, Van Aken H, Vermylen J. Anticoagulants and spinal-epidural anesthesia. Anesth Analg. 1994; 79:1165–77. DOI: 10.1213/00000539-199412000-00024. PMID: 7978443.
7. Aksay E, Kiyan S, Yuruktumen A, Kitis O. A rare diagnosis in emergency department: spontaneous spinal epidural hematoma. Am J Emerg Med. 2008; 26:835. DOI: 10.1016/j.ajem.2008.01.026. PMID: 18774053.
8. Groen RJ, van Alphen HA. Operative treatment of spontaneous spinal epidural hematomas: a study of the factors determining postoperative outcome. Neurosurgery. 1996; 39:494–508. DOI: 10.1097/00006123-199609000-00012.
9. Cai HX, Liu C, Zhang JF, Wan SL, Uchida K, Fan SW. Spontaneous epidural hematoma of thoracic spine presenting as Brown-Séquard syndrome: report of a case with review of the literature. J Spinal Cord Med. 2011; 34:432–6. DOI: 10.1179/107902611X13069205199468. PMID: 21903018. PMCID: PMC3152816.
10. Duffill J, Sparrow OC, Millar J, Barker CS. Can spontaneous spinal epidural haematoma be managed safely without operation? A report of four cases. J Neurol Neurosurg Psychiatry. 2000; 69:816–9. DOI: 10.1136/jnnp.69.6.816. PMID: 11080239. PMCID: PMC1737167.
11. Levy JM. Spontaneous lumbar subdural hematoma. AJNR Am J Neuroradiol. 1990; 11:780–1. PMID: 2114766.
12. Tabo E, Ohkuma Y, Kimura S, Nagaro T, Arai T. Successful percutaneous drainage of epidural abscess with epidural needle and catheter. Anesthesiology. 1994; 80:1393–5. DOI: 10.1097/00000542-199406000-00028. PMID: 8010484.
13. Lyu RK, Chen CJ, Tang LM, Chen ST. Spinal epidural abscess successfully treated with percutaneous, computed tomography- guided, needle aspiration and parenteral antibiotic therapy: case report and review of the literature. Neurosurgery. 2002; 51:509–12. DOI: 10.1097/00006123-200208000-00039. DOI: 10.1227/00006123-200208000-00039. PMID: 12182793.
14. Teo HE, Peh WC, Tan SB. Percutaneous drainage of a postoperative intraspinal hematoma using a Tuohy needle. Skeletal Radiol. 2003; 32:603–7. DOI: 10.1007/s00256-003-0666-5. PMID: 12898057.
15. Braun P, Kazmi K, Nogués-Meléndez P, Mas-Estellés F, Aparici-Robles F. MRI findings in spinal subdural and epidural hematomas. Eur J Radiol. 2007; 64:119–25. DOI: 10.1016/j.ejrad.2007.02.014. PMID: 17353109.
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