A Report of Cauda Equina Syndrome Caused by Spinal Epidural Hematoma, a Complication of Deep Vein Thrombosis (DVT) Management

Abstract

This case report delves into the infrequent yet substantial occurrence of cauda equina syndrome (CES) arising from a spinal epidural hematoma (SEH), a potential complication during deep vein thrombosis (DVT) treatment. An 83-year-old female patient previously diagnosed with various medical conditions, including moderate spinal stenosis, chronic kidney disease, and chronic lower extremity stasis, was detected with notable iliofemoral DVT during an office-based venous study. The patient was urgently referred to the Emergency Department. Following hospitalization, her cardiologist diagnosed DVT, prompted by the patient's report of significant swelling and pain in the left lower limb over the past week. A venous ultrasound unveiled occlusive DVT originating from the common femoral vein, extending down to the infrapopliteal vessels, with a complete absence of venous Doppler signal. Employing the ClotTriever device (Terumo Corporation, Shibuya City, Tokyo, Japan), a mechanical aspiration thrombectomy procedure, effectively resolved DVT. However, CES was diagnosed in the patient on a subsequent day due to the emergence of SEH. This case underscores the intricate balance required when managing DVT, involving anticoagulation or alternate therapies while acknowledging the potential risk of hemorrhagic complications leading to epidural hematoma and consequent CES. It is crucial for clinicians managing DVT and employing therapeutic strategies to be aware of this infrequent yet pivotal complication. This report highlights the significance of prompt identification and intervention in such cases, emphasizing the need for vigilance and understanding of potential complications during DVT treatment.