Abstract:According to our research, this is the first case described in the literature of spontaneous intracranial epidural hematoma secondary to the use of Xarelto ® . Spontaneous intracranial epidural hematomas are rarely described in the literature. They are associated with infectious diseases of the skull, coagulation disorders, vascular malformations of the dura mater and metastasis to the skull. Long-term post-marketing monitoring and independent reports will probably detect the full spectrum of hemorrhagic compl… Show more
“…Ruschel et al (2016) reported the first case of spontaneous intracranial epidural haematoma in a young patient on Rivaroxaban regime without any other medical co-morbidities. [16] There are increasing reports of bleeding and haemorrhagic complications in the elderly population on anti-coagulation medicines. Therefore, clinicians must be vigilant when prescribing the novel/newer or direct oral anticoagulants (NOAC or DOAC) such as Rivaroxaban, Apixaban and Dabigatran.…”
Background: Factor Xa inhibitors are widely used by the physicians to reduce the incidence of thrombosis in order to protect the cardiovascular function. Although complications of bleeding and spontaneous gastrointestinal sources have been reported before, there are very sporadic cases of spinal epidural haematoma causing neurological compromise. Case presentation: We report a case of spontaneous spinal epidural haematoma (SSEH) in an 85-year-old female patient treated with Rivaroxaban, a new agent to prevent the incidence of thrombo-embolic events. Anticoagulant therapy is a recognised risk factor in the development of spontaneous bleeding and haematomas. The patient presented to the emergency department with sudden onset of severe back pain in the lumbar spine associated with paraplegia in the lower limbs. Magnetic resonance imaging (MRI) of the spine demonstrated a SSEH from T12 to L5 affecting the cauda equina. Rivaroxaban was discontinued and the patient was monitored as an inpatient. There was gradual improvement in the symptoms of the lower limbs. Conclusion: This rare condition of incomplete cauda equina syndrome due to Rivaroxaban therapy has not been reported previously. Clinicians must have a high index of suspicion in patients on regular anti-coagulation regimen.
“…Ruschel et al (2016) reported the first case of spontaneous intracranial epidural haematoma in a young patient on Rivaroxaban regime without any other medical co-morbidities. [16] There are increasing reports of bleeding and haemorrhagic complications in the elderly population on anti-coagulation medicines. Therefore, clinicians must be vigilant when prescribing the novel/newer or direct oral anticoagulants (NOAC or DOAC) such as Rivaroxaban, Apixaban and Dabigatran.…”
Background: Factor Xa inhibitors are widely used by the physicians to reduce the incidence of thrombosis in order to protect the cardiovascular function. Although complications of bleeding and spontaneous gastrointestinal sources have been reported before, there are very sporadic cases of spinal epidural haematoma causing neurological compromise. Case presentation: We report a case of spontaneous spinal epidural haematoma (SSEH) in an 85-year-old female patient treated with Rivaroxaban, a new agent to prevent the incidence of thrombo-embolic events. Anticoagulant therapy is a recognised risk factor in the development of spontaneous bleeding and haematomas. The patient presented to the emergency department with sudden onset of severe back pain in the lumbar spine associated with paraplegia in the lower limbs. Magnetic resonance imaging (MRI) of the spine demonstrated a SSEH from T12 to L5 affecting the cauda equina. Rivaroxaban was discontinued and the patient was monitored as an inpatient. There was gradual improvement in the symptoms of the lower limbs. Conclusion: This rare condition of incomplete cauda equina syndrome due to Rivaroxaban therapy has not been reported previously. Clinicians must have a high index of suspicion in patients on regular anti-coagulation regimen.
“…However, spontaneous nontraumatic extradural hematomas are very rare and mostly occur due to vascular malformations,[12] sickle cell disease,[13] metastasis to the skull,[4] infectious diseases of the skull,[12] coagulation disorders,[14] and use of anticoagulants. [15]…”
Section: Discussionmentioning
confidence: 99%
“…However, spontaneous nontraumatic extradural hematomas are very rare and mostly occur due to vascular malformations, [12] sickle cell disease, [13] metastasis to the skull, [4] infectious diseases of the skull, [12] coagulation disorders, [14] and use of anticoagulants. [15] When hypofibrinogenemia is the cause of an intracranial extradural hematoma, time is the essence of successful therapy. Early identification and treatment is paramount to save the patient.…”
Spontaneous extradural hematoma is a well-documented but fairly rare condition, which can be associated with conditions such as vascular malformations, sickle cell disease, metastasis to the skull, infectious diseases of the skull, coagulation disorders, and use of anticoagulants. Of these, very few cases are of life-threatening extradural hematomas in adults, where hypofibrinogenemia is the cause of bleed, without any history of trauma. In this report, we have discussed the management of such a patient.
“…In the study it was reported that the active principle Rivaroxabana caused a secondary spontaneous epidural hematoma in the patient. (RUSCHEL et al, 2016). 6 According to Table 1, non-traumatic epidural hemorrhages are the cause of death in 67 people from Chen et al (2018) 8 in your study described that the prognosis of EDH is excellent if early diagnosis is made in conjunction with a surgical decompression.…”
Section: Physiopathologymentioning
confidence: 99%
“…(RUSCHEL et al, 2016). 6 According to Table 1, non-traumatic epidural hemorrhages are the cause of death in 67 people from Chen et al (2018) 8 in your study described that the prognosis of EDH is excellent if early diagnosis is made in conjunction with a surgical decompression. Besides, the authors highlight that spontaneous EDH is a rare condition, which may have some unusual triggers such as crying and hyperventilation, the presence of headaches with signs of increased intracranial pressure preceded by hyperventilation suggests that computed tomography examination should be done.…”
Introduction: epidural hematoma (EDH) is an event that can result in mortality and morbidity. Understanding it is critical to a fast diagnosis that enables successful management. In the perspective, this article aim to analyze the physiopathology of epidural hematoma. Specifically, the proposal develops a survey on the literature that covers the topic of epidural hematoma, to update and review in case reports the neurological damage and to seek the new concepts relative to the surgical practice, using the method of bibliographic study. Besides to bring some epidemiological data about this theme in Brazil in recent years. The results showed that the risks involved in the occurrence of an EDH go far beyond physical impacts, tumor lesions and infections, extending to cases of hemorrhage due to the use of drugs. Based on the DataSUS, there are no significant variations in hospitalizations due to intracranial hemorrhage or intracranial trauma in recent years. For treatment, minimally invasive surgery is one of the best alternatives to treat patients with EDH due to small incisions, reduced surgical time, reduced risk of anesthesia and avoid craniotomy. It is concluded that epidural hematoma requires an early diagnosis so that surgical intervention prevents other avoidable complications from occurring. Besides that, the public health system needs to have adequate structure, effective prevention strategies and improved EDH care.
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