A Spontaneous Spinal Epidural Hematoma in a Hemodialysis Patient: A Rare Entity

Deger, Serpil Muge; Emmez, Hakan; Bahadirli, Kenan; Kale, Aydemir; Ebinç, Fatma Ayerden; Türkoğlu, Melda; Arınsoy, Turgay; Sindel, Şükrü

doi:10.2169/internalmedicine.48.2335

Cited by 22 publications

(22 citation statements)

References 11 publications

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“…The predisposing factors were thought to be due to uremic platelet dysfunction and the use of heparin during hemodialysis in a setting of acute infectious vasculitis. 21 Both, subdural hematoma and abscess led to spinal cord compression that presented as paraplegia, progressed rapidly, and caused death in our patient.…”

Section: Discussionmentioning

confidence: 58%

Spinal Subdural Abscess: A Rare Complication of Decubitus Ulcer

Usoltseva

Medina‐Flores

Rehman

et al. 2014

Clinical Medicine & Research

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A male patient, aged 55 years, presented to the emergency room with complaints of bilateral upper extremity weakness. His past medical history was significant for paraplegia and neurogenic bladder from a spinal cord injury, complicated with decubitus ulcers and end-stage renal disease secondary to type II diabetes mellitus. His past surgical history was significant for posterior spine fusion with Harrington rod instrumentation at the level of T10. He developed subacute onset of bilateral upper extremity weakness and paresthesias on the day of presentation. He reported a 2-day history of neck and back pain that he initially contributed to his bedridden state. The patient denied fever, recent infections, or trauma. His vital signs were unremarkable. Physical examination revealed quadriparesis, absence of deep tendon reflexes, hypoesthesia, and decubitus ulcers (figure 1). He had a normal leukocyte count and elevated C-reactive protein. Blood cultures and cultures from the ulcers were obtained. With the concern of spinal cord compression based on presentation, intravenous corticosteroids and broad spectrum antibiotics were initiated. A magnetic resonance imaging (MRI) scan of the spine (figure 2) revealed large elongated epidural collection posteriorly within the cervical spine, extending into the thoracic spine and inferiorly. Spinal cord compression was prominent in the narrowed areas of disc-osteophyte complexes at the levels of C3-4 and C5-6, where the spinal cord was compressed between these disc-osteophyte complexes and the posterior epidural collection, with some mildly increased signal intensity within the cord. The lumbosacral spine was not well imaged due to artifacts of spinal hardware. Emergent drainage of the collection was indicated, but the patient declined. Per the patient's wishes, palliative care was initiated on the day Spinal subdural abscess (SSA) is an uncommon entity. The exact incidence is unknown, with very few cases reported in the literature. This condition may result in spinal cord compression, thus constituting a medical and neurosurgical emergency. The pathogenesis of SSA is not welldescribed, and the available knowledge is based on case observations only. There is only one case report that describes direct seeding from decubitus ulcers as a possible mechanism for development of SSA. We report a case of subacute onset of quadriplegia in a male patient, age 55 years, due to spinal cord compression from SSA and superimposed spinal subdural hematoma. The direct seeding from decubitus ulcers is thought to be the cause of infection in our patient. We present this case of SSA to elucidate and review the predisposing factors, pathogenesis, clinical presentation, diagnostic modalities, and treatment regarding management of this rare disorder.

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Section: Discussionmentioning

confidence: 58%

Spinal Subdural Abscess: A Rare Complication of Decubitus Ulcer

Usoltseva

Medina‐Flores

Rehman

et al. 2014

Clinical Medicine & Research

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“…6 Some predisposing factors are coagulopathy, arteriovenous malformation, anticoagulation, antiplatelet therapy, therapeutic thrombolysis for acute myocardial infarction, thrombocytopenia and conditions causing an increased intrathoracic/intra-abdominal pressure as in cough, sneezing, and Valsalva maneuver. [6][7][8][9][10][11][12] Traumatic SEH can be due to vertebral fractures, 13 postspinal surgeries, 14 lumbar puncture, 15 and any spinal intervention.…”

Section: Discussionmentioning

confidence: 99%

Acute Spontaneous Spinal Epidural Hematoma Secondary to Aspirin

Sharma¹,

Saseedharan²,

Pathrose³

et al. 2017

The Journal of Spinal Surgery

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Acute spontaneous spinal epidural hematoma (SSEH) is an extremely rare but a grave condition which if missed or diagnosed late can lead to serious life-debilitating neurological deficits. Numerous contributing factors are enlisted from idiopathic, trivial trauma to antiplatelet therapy. While aspirin is known to lower the risk of coronary artery disease and stroke, the risk of developing internal hemorrhages increases. Acute SSEH associated with aspirin is extremely rare. Emergency spinal decompression with evacuation of hematoma is the mainstay of treatment. We present a case of a 60-year-old male who presented to our hospital with sudden onset of backache followed by both lower limb paresis and inability to stand. The patient was on low-dose (75 mg) aspirin daily for ischemic heart disease. Emergency spinal decompression and hematoma evacuation was done due to worsening of neurological symptoms which led to improvement of symptoms.

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“…Risk factors associated with SSEH are proven to be are: anticoagulant therapy and thrombolysis therapy for cardiac related diseases [15][16][17], non-regulated hypertension [18], hemodialysis dependent renal disease [19], chronic antiplatelet drugs usage [2,15,17] and some congenital diseases with factor XI deficiency like hemophilia B [7].…”

Section: Discussionmentioning

confidence: 99%