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

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. CASE REPORTA 73-year-old male patient who visited with intermittent intolerable sharp and lancinating pain over the left anterior chest wall and the back for one month. He received 300 mg/day of gabapentin and 1,500 mg/day of valacyclovir orally for 7 days following diagnosis with acute herpes zoster at a local private clinic. The patient did not have any unusual history, including family history and surgical history. He had no systemic diseases such as hypertension, diabetes, and so on.His height and weight were 172 cm and 59 kg, respectively.Results of his blood tests such as activated partial thromboplastin time, prothrombin time, and platelet count all showed normal ranges.Physical examination revealed allodynia and hyperalgesia over the left T4 and T5 dermatomes. He complained severe pain in the affected area with a score of 8 or 9 on visual analog scale (VAS) where 0 indicated "no pain" and 10 indicated "the strongest pain imaginable." In particular, he was unable to sleep at night due to severe pain which interfered with his daily life.Under the diagnosis of post-herpetic neuralgia, the patient ￭Case Report￭

CT-guided Percutaneous Drainage of Intra-spinal Haematoma as an Alternative to Surgical Evacuation

“…An alternative treatment to consider is imaging-guided percutaneous drainage of the intra-spinal haematoma. This can be achieved using an 18G Tuohy needle, ideally under computed tomography (CT) guidance 2 , although fluoroscopic guidance can also be utilised 3 . Besides epidural hematomas, CT-guided aspiration has also been advocated for decompression of epidural abscesses 4 .…”