Spinal epidural hematoma associated with streptokinase treatment for myocardial infarction

Abstract

Study Design: Case Report. Objective: Thrombolytic therapy has become a routine and valuable care for selected patients with acute myocardial infarction (AMI) and rarely complicates with spinal epidural hemorrhage causing cord compression. Setting: Elazig, Turkey Case report: A 72-year-old woman developed spinal epidural hemorrhage following streptokinase and heparin administration for AMI. Back pain and lower extremity neurologic deficits ensued secondary to spinal cord compression by epidural hematoma. Diagnosis of spinal epidural hematoma, extending through T11 to L2 vertebra levels, could be accurately made by magnetic resonance imaging (MRI). Careful follow-up by neurologic examination, reversal of anticoagulant effects, anti-edema treatment with steroids and a low-intensity rehabilitation program maintained a full recovery. Follow-up MRI, 3 months after the accident, revealed complete resolution of the hematoma. Conclusion: Physicians should be aware of this rare complication secondary to thrombolytic therapy. A high index of suspicion for hemorrhagic complications is necessary, particularly in elderly patients under thrombolytic treatment regardless of spinal pain, and the patient's lethargic or confused status should be taken into account. MRI is a valuable imaging option that gives information on both localization and extent of lesion and recovery.

Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy

“…The majority of published reports involve spontaneous spinal or epidural hematomas after thrombolytic therapy. [52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68] Recent cases involve thrombolysis for myocardial infarction. Bleeding has been reported at all spinal levels-cervical, thoracic, and lumbar.…”

Remote spinal epidural haematoma after spinal anaesthesia presenting with a ‘spinal lucid interval’

“…Pregnancy, arterial hypertension and vasculitis, especially systemic lupus erythematosus can lead to spontaneous SEDH 3 7. The use of thrombolytic agents in the perioperative period seems to increase the risk 8. The presence of occult arteriovenous malformations is another possible cause of SEDH after neuraxial blocks.…”

Spontaneous spinal epidural haematoma in a geriatric patient on aspirin

“…15 Case reports of SSEH post-thrombolysis are prominent in the literature, 16,17 and clopidogrel therapy has also been implicated as a risk factor. 18 Aspirin-associated SSEH has been described only rarely.…”