Abstract
Spinal epidural hematoma (SEH) is a rare acute condition defined as a hematoma occurring at spinal epidural level. It is defined as “spontaneous” (SSEH) when possible causes have been ruled out; in other cases, clotting disorders and systemic lupus erythematosus have been associated with SEH. If identified rapidly, SEH can be completely cured, with complete recovery in about 50% of cases. We describe the case of an 86-year-old man affected by SEH, with rare anterior location, presenting with painful paraparesis and bladder dysfunction. The patient was taking warfarin for chronic atrial fibrillation. A prolongation of partial thromboplastin time was observed, consistent with the presence, in plasma, of previously unrecognized lupus anticoagulant antibodies (LA). The diagnosis of SEH was confirmed by MRI, and the patient was not surgically treated. Following a rehabilitation program, the patient had complete neurological recovery. Although the epidural lesion might have been a true case of SSEH, anticoagulation therapy and AL may have played a role in the pathogenesis, spread and spontaneous resolution of SEH. In cases of acute thoracic pain, associated with signs and symptoms of spinal cord compression, the diagnosis of SEH, which is a potentially devastating condition, must be carefully investigated by clinicians.
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Zuccarello M, Scanarini M, D’Avella D, Andrioli GC, Gerosa M. Spontaneous spinal extradural hematoma during anticoagulant therapy. Surg Neurol 1980; 14: 411.
Silber H. Complete nonsurgical resolution of a spontaneous spinal epidural hematoma. Am J Emerg Med 1996; 14: 391–3.
Goker B, Block JA. Spinal epidural hematoma complicating active systemic lupus erythematosus. Arthr Rheum 1999; 42: 577–84.
Kim WJ, Hong YK, Yoo WH. Epidural hematoma mimicking transverse myelitis in a patients with primary antiphosholipid syndrome. Rheumatol Int 2008; 28: 709–12.
Groen R. Non-operative treatment of spontaneous spinal epidural hematomas: a review of the literature and a comparison with operative cases. Acta Neurochir (Wien) 2004; 146: 103–10.
Kreppel D, Antoniadis G, Seeling W. Spinal hematoma: a literature survey with meta-analysis of 613 patients. Neurosurg Rev 2003; 26: 1–49.
Groen RJ, van Alphen HA. Operative treatment of spontaneous spinal epidural hematomas: a study of the factors determining postoperative outcome. Neurosurgery 1997; 39: 494–508.
Jackson R. A case of spinal apoplexy. Lancet 1869; 2: 5–6.
Bain N. A case of hematorrachis. BMJ 1897; 2: 455.
Jamioom ZA. Acute spontaneous spinal epidural hematoma: the influence of magnetic resonance imaging on diagnosis and treatment. Surg Neurol 1996; 46: 345–9.
Locke GE, Giorgio AJ, Biggers SLjr, Johnson AP, Salem F. Acute spinal epidural hematoma secondary to aspirin-induced prolonged bleeding. Surg Neurol 1976; 5: 293–6.
Yoshidome Y, Morimoto S, Tamura N et al. A case of primary antiphospholipid antibody syndrome presenting dysfunctyional uterine bleeding and cerebral infarction. Mod Rheumatol 2007; 17: 251–2.
Jayachandran NV, Rajasekhar L, Narsimulu G, Prasad V. Antiphospholipid antibody syndrome presenting with disseminated bleeding and spinal subdural hemorrhage. Spinal Cord 2007; 45: 753–5.
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Zuliani, G., Guerra, G., Nora, E.D. et al. Spinal anterior epidural hematoma in an elderly man with unrecognized lupic anticoagulant taking warfarin. Aging Clin Exp Res 23, 498–500 (2011). https://doi.org/10.1007/BF03325248
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DOI: https://doi.org/10.1007/BF03325248