Spinal Epidural Hematoma during Anticoagulant Therapy

Winer, Bertram M.; Horenstein, Simon; Starr, Albert

doi:10.1161/01.cir.19.5.735

Cited by 42 publications

(8 citation statements)

References 18 publications

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“…In our second case the epidural haemorrhage was apparently related to anticoagulant therapy, though this particular complication is extremely rare (Cloward and Yuhl, 1955;Alderman, 1956;Winer, Horenstein, and Starr, 1959). Devanney and Osher (1952), at the clinicopathological meeting of Cincinnati General Hospital, presented a patient 62 years of age who was on anticoagulant therapy for thrombophlebitis of the leg, who developed severe backache, bilateral posterior radicular pain, which progressing gradually resulted in paraparesis and urinary retention.…”

Section: Discussionmentioning

confidence: 77%

Chronic lumbar extradural haematoma simulating disc syndrome

Devadiga

Gass

1973

Journal of Neurology, Neurosurgery & Psychiatry

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SUMMARY Two patients presenting with a clinical picture of nerve root compression suggestive of the herniated disc syndrome are reported. In both the diagnosis proved to be chronic encapsulated extradural haematoma. Recognition of this entity at the time of surgical exposure should render the surgical dissection easier. The postoperative results in both were excellent. One of these patients was on chronic anticoagulant therapy and the unusual location and good prognosis of extradural haematoma in the lumbar spinal canal in such patients is emphasized. In the other, the haematoma developed after a minor back injury, which introduces medico-legal implications.The occurrence of spontaneous haemorrhage in the spinal extradural space, though infrequent, is now a classifiable pathological entity.

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Section: Discussionmentioning

confidence: 77%

Chronic lumbar extradural haematoma simulating disc syndrome

Devadiga

Gass

1973

Journal of Neurology, Neurosurgery & Psychiatry

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“…Winer et al 11, reviewed aft cases of spontaneous epidural haematomata reported to that time and found that approximately one-fourth of the cases in the literature had coagulation defects, including those with blood dyscrasias. In his review of the literature on spontaneous epidural haematoma, Gold 12 found that in onequarter of the reported cases coagulation defects had been present, mostly in elderly patients on long-term anticoagulation therapy.…”

Section: Discussionmentioning

confidence: 99%

Haematoma following epidural anaesthesia

Butler

Green

1970

Canad. Anaes. Soc. J.

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HAEMOIRRHAGE INTO the spinal epidural space associated with epidural catheterization and anticoagulation represents a rare and serious complication of spinal epidural anaesthesia with three cases 1,2,a described in the literature to the present time. Because of the increased use of this form of analgesia, the complication is probably even rarer than the cases reported would indicate. An awareness of this complication is no less compelling because of its potentially serious outcome, and possible remedy by prompt surgery. CASE I~EPOIRTA 70-year-old man was admitted to the hospital with a thirty-six hour history of numbness of the left foot, which later became cold, cyanotic and mildly painful. There was a history of "cold hands and feet" since 1962. At that time skin and muscle biopsies were performed and a diagnosis of scleroderma was made. Examination revealed thick skin and deformed nails of the fingers and toes. The left foot was cold, cyanotic to the level of the lateral maleolus, and pulses were absent. Pulse was present in the posterior tibial artery on the right. Pulses in the femoral and popliteal arteries were present and normal bilaterally.Before left anterior and posterior tibial embolectomy, epidural analgesia was induced using an epidural catheter inserted at the L-2--3 space and 2 per cent lidocaine. At the point of inserting the catheter no abnormal bleeding was noted. During the operation 10,000 units of heparin were given intravenously. The interval between catheterization and heparinization was about sixty minutes. Sympathetic blockade was maintained postoperatively by intermittent use of epidural lidocaine 1 per cent. Heparinization was continued as well. Clotting times were 9,0.5 minutes and 32 minutes at three and seven hours postoperatively. Thirteen hours after operation the epidural catheter was removed, as no further benefit was being obtained from sympathetic blockade. Clotting time was 24.5 minutes at that time. At about 24 hours after operation the patient began to complain of severe back pain. Examination by a house officer revealed no neurological deficit. Locally applied heat produced relief. At 25 hours postoperatively, the patient complained of numbness in both hands and the right leg, unassociated with back or extremity pain. Two hours later there was progression of the numbness and a "feeling of choking to death." Shortly after this, examination revealed a sensory level at T-2, paraplegia and severe weakness of the arm extensors, wrist extensors and flexors, and intrinsic hand muscles. Lumbar myelography demon-*Dep.t

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“…The association of spinal epidural hematoma with warfarin therapy has been described in literature, although many of the reported cases were anticoagulated within the therapeutic range. [1] SSEH should be suspected in any patient receiving anticoagulants who presents with local or referred back pain associated with limb weakness, sensory deficits or urinary retention. A 21-year-old male with SSEH who was receiving warfarin for hyperhomocysteinemia with sagittal sinus thrombosis is presented in this letter.…”

Section: Sirmentioning

confidence: 99%

“…[3] The term SSEH is given if no cause can be identified, which occurs in 40-50% of the cases. [1,2] Spinal epidural hematoma is believed to result from rupture of fragile epidural venous plexus after the sudden increase in intra-thoracic or intra-abdominal pressure. [1] An average of 3.8 spinal segments is involved.…”

Section: Anticoagulant Induced Spontaneous Spinal Epidural Hematomamentioning

confidence: 99%