Management of spinal epidural hematoma after tissue plasminogen activator - A case report

被引:52
作者
Connolly, ES
Winfree, CJ
McCormick, PC
机构
[1] Department of Neurological Surgery, Columbia-Presbyterian Medical Center, New York, NY
[2] Department of Neurological Surgery, Columbia-Presbyterian Medical Center, New York, NY 10032
关键词
epidural hematoma; spine; tissue plasminogen activator;
D O I
10.1097/00007632-199607150-00016
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Study Design. This case report illustrates a patient with a spontaneous epidural hematoma after tissue plasminogen activator therapy who presented 10 days after the incident with a resolving Brown-Sequard syndrome. Objectives. The treatment of this patient involves the principles of conservative follow-up directed by an improving examination an understanding of the pathophysiology of coagulopathy-induced spontaneous epidural bleeds. Summary of Background Data. The use of tissue plasminogen activator therapy for thrombolysis in patients with early acute myocardial infarction is becoming increasingly routine. Use is limited most significantly by bleeding complications. Recently, several groups have drawn attention to the neurologic complications associated with intracranial hemorrhage after tissue plasminogen activator therapy. Spontaneous spinal epidural hemorrhage has, by comparison, received little attention. The authors report the second case in the literature and the first without a history of antecedent trauma. Methods. The onset of the painful myelopathy in this patient was missed in the acute setting because of low suspicion. When the diagnosis was made, coadministered heparin had already been discontinued without reversal, and the patient's examination had already improved. Careful follow-up by neurologic examination and magnetic resonance imaging was obtained without spinal angiography being performed. Results. The patient regained his prehemorrhage neurologic status, experienced no further bleeding, and his coronary ischemia remained subclinical. Conclusions. Spinal epidural hemorrhage secondary to thrombolytic therapy is becoming increasingly common. Urgent surgical decompression is generally warranted to preserve neurologic function. In cases where the deficit is minimal or resolving, a conservative approach may be warranted with magnetic resonance imaging but no angiographic follow-up.
引用
收藏
页码:1694 / 1698
页数:5
相关论文
共 29 条
[2]   SPONTANEOUS CERVICAL EPIDURAL HEMATOMA - A CONSIDERATION OF ETIOLOGY [J].
BEATTY, RM ;
WINSTON, KR .
JOURNAL OF NEUROSURGERY, 1984, 61 (01) :143-148
[3]   INTRACEREBRAL HEMORRHAGE COMPLICATING INTRAVENOUS TISSUE PLASMINOGEN-ACTIVATOR TREATMENT [J].
CARLSON, SE ;
ALDRICH, MS ;
GREENBERG, HS ;
TOPOL, EJ .
ARCHIVES OF NEUROLOGY, 1988, 45 (10) :1070-1073
[4]   THROMBOLYSIS IN MYOCARDIAL-INFARCTION (TIMI) TRIAL, PHASE-I - A COMPARISON BETWEEN INTRAVENOUS TISSUE PLASMINOGEN-ACTIVATOR AND INTRAVENOUS STREPTOKINASE - CLINICAL FINDINGS THROUGH HOSPITAL DISCHARGE [J].
CHESEBRO, JH ;
KNATTERUD, G ;
ROBERTS, R ;
BORER, J ;
COHEN, LS ;
DALEN, J ;
DODGE, HT ;
FRANCIS, CK ;
HILLIS, D ;
LUDBROOK, P ;
MARKIS, JE ;
MUELLER, H ;
PASSAMANI, ER ;
POWERS, ER ;
RAO, AK ;
ROBERTSON, T ;
ROSS, A ;
RYAN, TJ ;
SOBEL, BE ;
WILLERSON, J ;
WILLIAMS, DO ;
ZARET, BL ;
BRAUNWALD, E .
CIRCULATION, 1987, 76 (01) :142-154
[5]  
CORREA AV, 1978, SURG NEUROL, V10, P227
[6]   SPINAL EXTRADURAL HEMORRHAGE [J].
CUBE, HM .
JOURNAL OF NEUROSURGERY, 1962, 19 (02) :171-+
[7]   CHRONIC LUMBAR EXTRADURAL HEMATOMA SIMULATING DISK SYNDROME [J].
DEVADIGA, KV ;
GASS, HH .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 1973, 36 (02) :255-259
[8]   SPONTANEOUS CERVICAL EPIDURAL HEMORRHAGE, ANTERIOR CORD SYNDROME, AND FAMILIAL VASCULAR MALFORMATION - CASE-REPORT [J].
FOO, D ;
CHANG, YC ;
ROSSIER, AB .
NEUROLOGY, 1980, 30 (03) :308-311
[9]   COMPLICATIONS OF SPINAL-CORD ARTERIOGRAPHY - PROSPECTIVE ASSESSMENT OF RISK FOR DIAGNOSTIC PROCEDURES [J].
FORBES, G ;
NICHOLS, DA ;
JACK, CR ;
ILSTRUP, DM ;
KISPERT, DB ;
PIEPGRAS, DG ;
WIEBERS, DO ;
EARNEST, F ;
AXLEY, PL .
RADIOLOGY, 1988, 169 (02) :479-484
[10]   CAVERNOUS ANGIOMAS AND ARTERIOVENOUS-MALFORMATIONS OF THE SPINAL EPIDURAL SPACE - REPORT OF 11 CASES [J].
GRAZIANI, N ;
BOUILLOT, P ;
FIGARELLABRANGER, D ;
DUFOUR, H ;
PERAGUT, JC ;
GRISOLI, F .
NEUROSURGERY, 1994, 35 (05) :856-863