Spinal epidural hematoma after lumbar catheter insertion in a patient who underwent TEVAR for an aneurysm of the descending aorta
Journal
Journal of Spine & Neurosurgery
Date Issued
2020-01-29
Author(s)
Bushinoska, Jasna
Asani, Elmedina
Abstract
We present a case of spinal epidural hematoma after Lumbar
catheter insertion in a patient who underwent TEVAR for an
aneurysm of the descending aorta. Spinal epidural hematoma
(SEH) is a relatively rare entity and has been reported to occur
in patients who receive anti-coagulant therapy, have bleeding
disorders, or after traumatic needle insertion. In our case, the
epidural hematoma occurred 4 hours after catheter insertion, in
a patient who received anticoagulant and antiplatelet medication.
In these cases, early detection of symptoms and rapid diagnosis
are an imperative. Our patient’s diagnosis was done 5 hours after
symptom development and it consisted of thoracolumbar MRI that
showed a spinal hyper-acute epidural hematoma extending from
T9-T10 to L4-L5 and the affected segments of the spinal cord and
conus medullar showed edema, most significantly at L1-L2 levels.
A neurosurgical consult was done immediately after obtaining the
results and within six hours after neurosurgical symptoms occurred,
the patient underwent spinal decompression, the hematoma was
evacuated and the patient regained motor function in her legs. During
her stay at the cardiac ICU, the doctors administrated to our patient
antiplatelet medication alongside low-molecular-weight heparin
(LMWH)–inj. Clexane 40 I.U., against our recommendations. Due
to this, our patient developed re-bleeding and we had to perform
a second surgery, to do a more extensive spinal decompression
and to evacuate the hematoma. Neurologic rehabilitation after the
second surgery was difficult, but with extensive physical therapy, we
have managed to achieve some improvement, with motor response
2\5 on the left leg and 3\5 on the right leg.
Although anticoagulants and\or antiplatelet medication are a
must in endovascular procedures and are considered safe to use
during epidural analgesia, special attention and care to epidural
hematoma should be given, especially in cases when an epidural
catheter placement is needed.
catheter insertion in a patient who underwent TEVAR for an
aneurysm of the descending aorta. Spinal epidural hematoma
(SEH) is a relatively rare entity and has been reported to occur
in patients who receive anti-coagulant therapy, have bleeding
disorders, or after traumatic needle insertion. In our case, the
epidural hematoma occurred 4 hours after catheter insertion, in
a patient who received anticoagulant and antiplatelet medication.
In these cases, early detection of symptoms and rapid diagnosis
are an imperative. Our patient’s diagnosis was done 5 hours after
symptom development and it consisted of thoracolumbar MRI that
showed a spinal hyper-acute epidural hematoma extending from
T9-T10 to L4-L5 and the affected segments of the spinal cord and
conus medullar showed edema, most significantly at L1-L2 levels.
A neurosurgical consult was done immediately after obtaining the
results and within six hours after neurosurgical symptoms occurred,
the patient underwent spinal decompression, the hematoma was
evacuated and the patient regained motor function in her legs. During
her stay at the cardiac ICU, the doctors administrated to our patient
antiplatelet medication alongside low-molecular-weight heparin
(LMWH)–inj. Clexane 40 I.U., against our recommendations. Due
to this, our patient developed re-bleeding and we had to perform
a second surgery, to do a more extensive spinal decompression
and to evacuate the hematoma. Neurologic rehabilitation after the
second surgery was difficult, but with extensive physical therapy, we
have managed to achieve some improvement, with motor response
2\5 on the left leg and 3\5 on the right leg.
Although anticoagulants and\or antiplatelet medication are a
must in endovascular procedures and are considered safe to use
during epidural analgesia, special attention and care to epidural
hematoma should be given, especially in cases when an epidural
catheter placement is needed.
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