Spontaneous Cervical Epidural Hematoma Following Anti-Coagulant Medications with Quadriparesis: A Case Report and Narrative Review
Volume 7 | Issue 2 | July-December 2022 | Page: 23-27 | Vijay Kumar Loya, Charanjit Singh Dhillon, T.V. Krishna Narayana, Chetan S. Pophale, Sameen V.K.
DOI: https://doi.org/10.13107/ijs.2022.v07i02.41
Authors: Vijay Kumar Loya [1], Charanjit Singh Dhillon [2], T.V. Krishna Narayana [3], Chetan S. Pophale [2], Sameen V.K [4]
[1] Department of Spine Surgery, Germanten Hospital, Hyderabad, Telangana, India.
[2] Department of Spine Surgery, M.I.O.T International, Chennai, Tamil Nadu, India.
[3] Department of Spine Surgery, Udai Omni Hospital, Hyderabad, Telangana, India.
[4] Department of Spine Surgery, Government Medical College, Kottayam, Kerala, India.
Address of Correspondence
Dr. Vijay Kumar Loya,
Consultant Spine Surgeon, Germanten Hospital, Hyderabad, Telangana, India.
E-mail: dr.vijaykumarloya@gmail.com.
Abstract
Spontaneous spinal epidural hematoma is an uncommon entity. We present a 42-year gentleman who was a known case of chronic deep vein thrombosis of leg on Tab. Acitrom (6 mg OD) for one & half year presented with sudden-onset weakness of bilateral upper & lower limbs with bowel & bladder involvement. MRI showed ventral epidural haematoma extending from the lower margin of C2 to C6 with severe canal compromise. Patient underwent emergency decompression with hematoma evacuation on the same day within 06 hours of presentation to our centre. At a 2-year follow-up, the patient has recovered good bowel and bladder control and has a residual left leg foot drop. Spontaneous spinal epidural hematoma is a rare condition where early management is the key. If associated with neuro deficits, early decompression (<48 hours) is indicated for a better prognosis. This case report highlights the fact, if dealt proactively patient can have a good neurologic recovery.
Keywords: Epidural hematoma, Quadriparesis, Cervical spine, Anti-coagulants
References
1. Jackson R. CASE OF SPINAL APOPLEXY. The Lancet. 1869 Jul 3;94(2392):5–6.
2. Kreppel D, Antoniadis G, Seeling W. Spinal hematoma: a literature survey with meta-analysis of 613 patients. Neurosurg Rev. 2003 Jan;26(1):1–49.
3. MR imaging of spinal haematoma: a pictorial review – PMC [Internet]. [cited 2023 Mar 7]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6541191/
4. Hadley MN, Walters BC. Introduction to the Guidelines for the Management of Acute Cervical Spine and Spinal Cord Injuries. Neurosurgery. 2013 Mar;72 Suppl 2:5–16.
5. Beatty RM, Winston KR. Spontaneous cervical epidural hematoma. A consideration of etiology. J Neurosurg. 1984 Jul;61(1):143–8.
6. Baeesa S, Jarzem P, Mansi M, Bokhari R, Bassi M. Spontaneous Spinal Epidural Hematoma: Correlation of Timing of Surgical Decompression and MRI Findings with Functional Neurological Outcome. World Neurosurg. 2019 Feb;122:e241–7.
7. Gopalkrishnan CV, Dhakoji A, Nair S. Spontaneous cervical epidural hematoma of idiopathic etiology: Case report and review of literature. J Spinal Cord Med. 2012 Mar;35(2):113–7.
8. Lee HH, Park SC, Kim Y, Ha YS. Spontaneous Spinal Epidural Hematoma on the Ventral Portion of Whole Spinal Canal: A Case Report. Korean J Spine. 2015 Sep;12(3):173–6.
9. Raasck K, Khoury J, Aoude A, Abduljabbar F, Jarzem P. Nonsurgical management of an extensive spontaneous spinal epidural hematoma causing quadriplegia and respiratory distress in a choledocholithiasis patient. Medicine (Baltimore). 2017 Dec 22;96(51):e9368.
10. Zhong W, Chen H, You C, Li J, Liu Y, Huang S. Spontaneous spinal epidural hematoma. J Clin Neurosci. 2011 Nov;18(11):1490–4.
11. Groen RJ, Ponssen H. The spontaneous spinal epidural hematoma. A study of the etiology. J Neurol Sci. 1990 Sep;98(2–3):121–38.
12. Agnetti V, Monaco F, Mutani R. Post-convulsive spinal epidural haematoma in ankylosing spondylitis. Eur Neurol. 1979;18(4):230–3.
13. Vierunen RM, Koivikko MP, Siironen JO, Kerttula LI, Bensch FV. Post-traumatic spinal hematoma in ankylosing spondylitis. Emerg Radiol. 2021 Jun;28(3):601–11.
14. Hanna G, Uddin SA, Trontis A, Ross L, Drazin D, Kim TT, et al. Epidural hematoma in patients with ankylosing spondylitis requiring surgical stabilization: a single-institution retrospective review with literature analysis. Neurosurg Focus. 2021 Oct;51(4):E5.
15. Liao CC, Lee ST, Hsu WC, Chen LR, Lui TN, Lee SC. Experience in the surgical management of spontaneous spinal epidural hematoma. J Neurosurg. 2004 Jan;100(1 Suppl Spine):38–45.
| How to Cite this Article: Loya VK, Dhillon CS, Narayana TVK, Pophale CS, Sameen VK | Spontaneous Cervical Epidural Hematoma Following Anti-Coagulant Medications with Quadriparesis: A Case Report and Narrative Review | International Journal of Spine | July-December 2022; 7(2): 23-27 | https://doi.org/10.13107/ijs.2022.v07i02.41 |
