Spontaneous Spinal Epidural Hematoma With Spinal Cord Compression Complicating Plasma Cell Myeloma

Hayem, Gilles; Deutsch, Éric; Roux, Sophie; Palazzo, Élisabeth; Grossin, M; Meyer, Olivier

doi:10.1097/00007632-199811150-00015

Cited by 22 publications

(23 citation statements)

References 18 publications

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“…In the spine, such hemorrhages have been associated with pregnancy [16], multiple myeloma [17], Paget disease [18], panarteritis nodosa [19], and following tissue plasminogen activator or heparin therapies [2,3]. Intracranially, spontaneous epidural hemorrhage may occur in the presence of metastases [20,21], infection [4,5,22], or vascular lesions such as middle meningeal artery aneurysms [1] or diploic venous thrombosis [23].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous epidural hemorrhage in chronic renal failure

et al. 2004

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Spontaneous epidural hemorrhage has been described in a variety of clinical scenarios, including chronic renal failure (CRF). During hemodialysis, patients with CRF rarely develop spinal or cranial epidural hematomas. Such hemorrhages have been attributed to intracranial pressure fluctuations during hemodialysis, heparin administration, uremic-platelet syndrome, or hypertension. Although the exact pathophysiology is not understood, this rare consequence of hemodialysis has been well documented in the literature. Hemorrhage in the absence of hemodialysis therapy in a CRF patient, however, has not been previously reported. We report a 16-year-old boy with no history of trauma who woke in the morning with severe headache and resultant neurological deterioration. He was found to have a large left temperoparietal epidural hematoma and underwent urgent surgical evacuation. Postoperatively he developed a contralateral extra-axial hematoma that did not require surgical intervention. He recovered completely, with no significant neurological deficit. This unique presentation of spontaneous intracranial epidural hemorrhage in an adolescent not receiving hemodialysis highlights a rare, but serious, complication of CRF.

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Section: Discussionmentioning

confidence: 99%

Spontaneous epidural hemorrhage in chronic renal failure

et al. 2004

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“…Malignancy as a cause has only been described four times before [2][3][4][5]. Three of the patients had a haematological malignancy.…”

Section: Spontaneous Spinal Epidural Haematomamentioning

confidence: 99%

“…Three of the patients had a haematological malignancy. Two had chronic myelogenous leukaemia with elevated immature white cell and platelet counts [3,5] and the other had multiple myeloma in the spine with normal blood parameters but had received prophylactic low molecular weight heparin prior to onset of haematoma [2]. The authors suspected that the tumour may have caused epidural inflammation and epidural venous plexus fragility resulting in the haematoma.…”

Section: Spontaneous Spinal Epidural Haematomamentioning

confidence: 99%

“…A number of potential causes for SSEH have been identified including anticoagulant and antiplatelet use, bleeding diatheses, vascular malformations and hypertension but there have only been four previously described cases where an underlying malignancy has been responsible [2][3][4][5]. Three of those cases were haematological malignancies, the fourth metastatic bronchial adenocarcinoma.…”

Section: Introductionmentioning

confidence: 99%

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Metastatic thymoma presenting as spontaneous epidural lumbar haematoma

2015

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We report the case of a 44-year-old man who was found to have metastatic thymoma to his lumbar spine presenting as a spontaneous epidural haematoma. The man presented with back pain and cauda equina like symptoms in the absence of trauma, antiplatelet or anticoagulant agents. Following a laminectomy and excision of the epidural collection he made a full neurological recovery. Histopathology of the haematoma demonstrated metastatic thymoma. To the best of our knowledge, this is the first such case of metastatic thymoma to the lumbar spine presenting as a spontaneous epidural collection. We believe, in all patients with spontaneous spinal epidural haematoma and a background of malignancy, histopathological analysis should be sought.

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“…[1][2][3][4] Around 2-8% of hemophilic patients develop hematomas of the CNS, of which around 10% are in the spine. 5 These hematomas present usually with rapidly developing paraparesis and any delay in diagnosis may be disastrous.…”

Section: Introductionmentioning

confidence: 99%

Nonoperative management of spontaneous epidural hematoma in hemophilia A

et al. 2017

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Background: Spontaneous epidural haematoma is a rare clinical presentation and may be associated with coagulation disorders. These hematomas present usually with rapidly developing paraparesis and any delay in diagnosis may be disastrous.Methods: We included five patients of spontaneous epidural hematomas in hemophilia A with neurological deficit. They were treated non-operatively with factor VIII replacement therapy with oral tranexamic acid and intravenous dexamethasone as per protocol. All patients were followed up for 6 months and assessed for signs of neurological recovery and radiological resolution of hematoma.Results: All patients had complete motor recovery within 3 months of initiating treatment and showed resolution of hematoma on MRI. Conclusions: Prognosis following early initiation of correction of factor deficiency is good.

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Spontaneous Spinal Epidural Hematoma With Spinal Cord Compression Complicating Plasma Cell Myeloma

Abstract: This is the first reported case of spontaneous epidural hematoma ascribed to underlying malignant disease, with confirmation of the diagnosis by postmortem examination. Possible mechanisms include tumor-related epidural inflammation and fragility of epidural venous plexuses.

Cited by 22 publications

References 18 publications

Spontaneous epidural hemorrhage in chronic renal failure

Spontaneous epidural hemorrhage in chronic renal failure

Metastatic thymoma presenting as spontaneous epidural lumbar haematoma

Nonoperative management of spontaneous epidural hematoma in hemophilia A

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