Advertisement

Neurological Sciences

, Volume 32, Issue 4, pp 687–689 | Cite as

Relapsed spontaneous spinal epidural hematoma associated with aspirin and clopidogrel

  • Seong Hoon Lim
  • Bo Young Hong
  • Ye Rim Cho
  • Han Seung Kim
  • Jong In Lee
  • Hye Won Kim
  • Young Jin Ko
Case Report

Abstract

An acute spontaneous spinal epidural hematoma (SSEH) is a rare spinal pathology. A 57-year-old man who had hypertension and had been on dual antiplatelet therapy with aspirin and clopidogrel for primary prevention presented with the sudden onset of mid back pain and monoplegia of the left lower extremity. Magnetic resonance imaging revealed an epidural hematoma, and the patient underwent emergency hemilaminectomy for evacuation. However, the symptoms worsened, and complete paraplegia developed. A second procedure to remove the recurrent hematoma was performed. No vascular malformation or other possible cause for SSEH was found other than the aspirin and clopidogrel medication. This case report describes relapsed SSEH caused by the combination of aspirin and clopidogrel medication and urges caution in prescribing dual antiplatelet agents.

Keywords

Aspirin Clopidogrel Spinal epidural hematoma Antiplatelet agent Paraplegia 

Notes

Conflict of interest

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated.

References

  1. 1.
    Pullarkat VA, Kalapura T, Pincus M, Baskharoun R (2000) Intraspinal hemorrhage complicating oral anticoagulant therapy: an unusual case of cervical hematomyelia and a review of the literature. Arch Intern Med 160:237–240PubMedCrossRefGoogle Scholar
  2. 2.
    Finsterer J, Seywald S, Stollberger C et al (2008) Recovery from acute paraplegia due to spontaneous spinal, epidural hematoma under minimal-dose acetyl-salicylic acid. Neurol Sci 29:271–273PubMedCrossRefGoogle Scholar
  3. 3.
    Moon HJ, Kim JH, Kwon TH, Chung HS, Park YK (2009) Spontaneous spinal epidural hematoma: an urgent complication of adding clopidogrel to aspirin therapy. J Neurol Sci 285:254–256PubMedCrossRefGoogle Scholar
  4. 4.
    Second Chinese Cardiac Study (CCS-2) Collaborative Group (2000) Rationale, design and organization of the Second Chinese Cardiac Study (CCS-2) a randomized trial of clopidogrel plus aspirin, and of metoprolol, among patients with suspected acute myocardial infarction. Second Chinese Cardiac Study (CCS-2) Collaborative Group. J Cardiovasc Risk 7:435–441Google Scholar
  5. 5.
    Antithrombotic Trialists’ Collaboration (2002) Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 324:71–86Google Scholar
  6. 6.
    Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK (2001) Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 345:494–502PubMedCrossRefGoogle Scholar
  7. 7.
    Hentschel SJ, Woolfenden AR, Fairholm DJ (2001) Resolution of spontaneous spinal epidural hematoma without surgery: report of two cases. Spine (Phila Pa 1976) 26:E525–E527CrossRefGoogle Scholar
  8. 8.
    Kreppel D, Antoniadis G, Seeling W (2003) Spinal hematoma: a literature survey with meta-analysis of 613 patients. Neurosurg Rev 26:1–49PubMedCrossRefGoogle Scholar
  9. 9.
    McQuarrie IG (1978) Recovery from paraplegia caused by spontaneous spinal epidural hematoma. Neurology 28:224–228PubMedGoogle Scholar
  10. 10.
    Sanossian N, Saver JL, Rajajee V et al (2006) Premorbid antiplatelet use and ischemic stroke outcomes. Neurology 66:319–323PubMedCrossRefGoogle Scholar
  11. 11.
    Chen ZM, Jiang LX, Chen YP et al (2005) Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet 366:1607–1621PubMedCrossRefGoogle Scholar
  12. 12.
    Diener HC, Bogousslavsky J, Brass LM et al (2004) Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet 364:331–337PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Seong Hoon Lim
    • 1
  • Bo Young Hong
    • 1
  • Ye Rim Cho
    • 1
  • Han Seung Kim
    • 1
  • Jong In Lee
    • 1
  • Hye Won Kim
    • 1
  • Young Jin Ko
    • 1
  1. 1.Department of Rehabilitation Medicine, Seoul St. Mary Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea

Personalised recommendations