Acute spontaneous spinal epidural hematoma: an important differential diagnosis in patients under clopidogrel therapy

BACKGROUND CONTEXT: Spontaneous spinal epidural hematoma (SSEH) is an infrequent spinal pathology. Although it is related to numerous risk factors, its etiology remains unclear. PURPOSE: The aim of this article was to review the most important data in the literature about SSEH and to propose clopidogrel (Plavix (R)) therapy as a risk factor. STUDY DESIGN: Case report. METHODS: A 79-year-old woman was hospitalized in our unit with posterior thoracic pain and urinary retention of 72 hours duration. A clinical history was taken, and laboratory and imaging tests were performed. Urgent surgical decompression was performed, showing an epidural hematoma. Postoperative bacteriological cultures were negative, and microscopic analysis confirmed the diagnosis. RESULTS: For this patient, clopidogrel (Plavix (R) ) therapy was the only risk factor related to SSEH. CONCLUSIONS: In any patient under clopidogrel (Plavix (R): Sanofi-Synthelabo, Bristol-Myers Squibb/Sanofi Pharmaceuticals) therapy and with a typical clinical presentation, SSEH should be suspected and quickly diagnosed, regardless of hemostatic status or the absence of other major risk factors. (C) 2008 Elsevier Inc. All rights reserved.