Cervical epidural haematoma with clivus fracture: case report

Melo, Paulo Mácio Porto de; Kadri, Paulo Abdo do Seixo; Oliveira, Jean Gonçalves de; Suriano, Ítalo Capraro; Cavalheiro, Sérgio; Braga, Fernando Menezes

doi:10.1590/s0004-282x2003000300034

Cited by 9 publications

(7 citation statements)

References 21 publications

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“…Although debate surrounding the optimal treatment of cervical epidural hematomas continues, most authors have suggested surgical therapy for acute cases with neurological deficit. 2,5,24,25 Chang et al advocated that the lesions are active in cases with contrast uptake in MRI and an agressive surgical therapy is warranted. 26 The hematoma is located at the posterior epidural space in most cases.…”

Section: Case Reportmentioning

confidence: 99%

“…1 Usually observed in cervical and thoracic regions, SCEHs are the rarest among the pathologies causing spinal cord compression. [2][3][4][5] Epidural hematomas are generally located to the posterior aspect of the spinal cord owing to close relationship of the dura with the posterior longitudinal ligament at the anterior aspect of the dural sac. 2,3,5,6 Epidural hematomas located in the cervical region manifest with acute or chronic symptoms, although neck pain or root pain are the most common complaints.…”

Section: Introducti̇onmentioning

confidence: 99%

“…2,3,5,6 Epidural hematomas located in the cervical region manifest with acute or chronic symptoms, although neck pain or root pain are the most common complaints. Motor and/or sensory deficits accompany the clinical picture depending on the magnitude of spinal cord compression.…”

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confidence: 99%

“…SCEH may complicate hypertension, vascular malformations, bleeding disorders, anticoagulant therapy, tumors, pregnancy, vasculitic syndromes, surgical interventions, and epidural anesthesia. [3][4][5][6]9,10 In this case, we aimed to presented a SCEH case. There was no ethical problem in this case.…”

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Spontaneous Cervi̇cal Epi̇dural Hematoma Due to Oral Anti̇coagulant Use

Altınbilek¹,

Öztürk²,

Çaltılı³

et al. 2014

J Pharm Sci Innov

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Spontaneous spinal epidural hematoma (SCEH) is a considerbaly rare clinical condition. It may lead to persistent neurological deficits or even death unless recognized and treated early in its course. It usually occurs after trauma but may also develop spontaneously. Majority of cases can be diagnosed with a detailed neurological examination and magnetic resonance imaging (MRI). Urgent surgical tehrapy is the preferred mode of treatment in advanced cases while a conservative approach is selected for cases with mild neurological deficit. MRI is regarded as the imaging modality of choice fort he diagnosis of SCEH. We report a case of nontrumatic SCEH after oral anticoagulant (OAC) use that presented with sudden-onset paraplegia. We also reviewed the relevant literature. Keywords: Spinal epidural hematoma, nontraumatic, oral anticoagulant, MRI, human prothrombin complex concentrate INTRODUCTİONSpontaneous spinal epidural hematoma (SCEH) is a rare condition and it is the rarest cause of neck pain. However, it is a medical emergency since it may lead to permenant neuroogical deficit or even death if missed or left untreated. The clinical picture usually starts with pain corresponding to the level of bleeding and progresses into neurological deficits. Depending on the site of occurrence, it may cause paraparesia, quadriparesia, and sphincteric malfunction. 1Usually observed in cervical and thoracic regions, SCEHs are the rarest among the pathologies causing spinal cord compression.2-5 Epidural hematomas are generally located to the posterior aspect of the spinal cord owing to close relationship of the dura with the posterior longitudinal ligament at the anterior aspect of the dural sac. 2,3,5,6 Epidural hematomas located in the cervical region manifest with acute or chronic symptoms, although neck pain or root pain are the most common complaints. Motor and/or sensory deficits accompany the clinical picture depending on the magnitude of spinal cord compression.2,7,8 SCEH follows a trauma most of the time, although spontaneous SCEHs have also rarely been described. SCEH may complicate hypertension, vascular malformations, bleeding disorders, anticoagulant therapy, tumors, pregnancy, vasculitic syndromes, surgical interventions, and epidural anesthesia. [3][4][5][6]9,10 In this case, we aimed to presented a SCEH case. There was no ethical problem in this case. Case reportA 26-year-old man presented with sudeen-onset neck pain and wekaness in arms and legs. He had been on oral antioagulant therapy (warfarin sodium 5 mg for 30 days). His genreal status was moderately impaired and he was consicous, cooperated and oriented. On physical examination the cardiac sounds were normal, abdomen was nontender, pupils were isocoric, and cranial nerves were roughly intact. Motor examination revealed a muscle strength of 1/5 in left wrist flexion and extension and 1/5 in right wrist flexion and extension. Sensory examination showed anesthesia on T1 dermatome and its continuity. TCR was bilaterally negative. His vital sgins were a...

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Section: Case Reportmentioning

confidence: 99%

Section: Introducti̇onmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Spontaneous Cervi̇cal Epi̇dural Hematoma Due to Oral Anti̇coagulant Use

Altınbilek¹,

Öztürk²,

Çaltılı³

et al. 2014

J Pharm Sci Innov

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“…Lesões do clivus com intensidade baixa ou i n t e rmediária em T2 são raras, sendo verificadas em alguns casos de DF e em metástases osteoblásticas do clivus 2 5 , 2 8 , 2 9 . Lesões traumáticas envolvendo o clivus são incomuns 30 .…”

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Displasia fibrosa do clivus: relato de caso

Falavigna

Borba

Teles

2006

Arq. Neuro-Psiquiatr.

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Fibrous dysplasia of the clivus: case report ABSTRACT -We describe the case of a 43 year-old woman with c h ronic headache and diplopia. The neurorradiologic exam showed volume increase and alteration in the bone density of the clivus. She was submitted to surgery and the anatomopathologic evidenced fibrous dysplasia. Other 14 of about fibrous dysplasia involving the clivus are related in the literature. We discuss clinical aspects, image exams, histology and treatment of this rare presentation of the disease.KEY WORDS: clivus, fibrous dysplasia, cranial fossa posterior. vus (Fig 1). O tratamento cirúrgico adotado foi a via transmaxilar com osteotomia tipo Lefort e posterior re c o n s t ru ç ã o com placas e parafusos, não tendo havido interc o rr ê n c i a s (Fig 2). O exame anatomopatológico mostrou tecido ósseo i m a t u ro e matriz óssea, compatíveis com displasia fibro s a (Fig 3). A paciente apresentou melhora da diplopia três semanas após a ciru rgia. Houve anuência para publicação do caso, com assinatura de consentimento informado. DISCUSSÃO DF, distúrbio esquelético caracterizado pela proliferação extensiva de tecido fibroso na medula óssea e que leva a lesões osteolíticas, fraturas e deform ações do osso acometido, re p resenta 2,5% de todos os tumores ósseos e 7% dos tumores ósseos benign o s 9 . Este processo afeta principalmente extre m i d a d e s de ossos longos 6 . A DF divide-se em forma monostó-tica, que envolve um ou mais ossos contíguos (70%), e forma polistótica, que se caracteriza pelo acometimento de múltiplas áreas do esqueleto (30%) 6 . Há uma terceira forma, denominada síndrome de McCune-Albright, cuja característica constitui-se na comDisplasia fibrosa (DF) é um tumor benigno idiopático no qual a medula do osso é substituída por tecido fibroósseo que leva à distorção e superc re s c imento do osso afetado 1 . A DF acomete diversos ossos, principalmente os longos, como fêmur e tíbia, base do crânio e ossos faciais. Entretanto, a displasia fib rosa do clivus (DFC) é pouco estudada e raramente re l a t a d a 2 , havendo na literatura relato de apenas 14 c a s o s 2-8 ( Tabela 1). Distinguir esta entidade de processos mais agressivos que afetam o clivus é essencial para seu manejo.O objetivo do trabalho é relatar um caso de DFC, d e s c revendo suas manifestações clínicas, caracterís-ticas radiológicas e tratamento. CASOMulher de 43 anos, com história de cefaléia crônica e diplopia de início há 48 horas. Apresentou, ao exame neurológico, paresia da mirada lateral do olho esquerdo. A investigação neuro rradiológica com tomografia computadorizada (TC) e ressonância magnética (RM) evidenciaram aumento de volume e alteração da densidade óssea do cli-

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