Spontan Spinal Epidural Hematom
Özet
Spontan spinal epidural hematom (SEH), spinal epidural boşlukta kan birikmesi sonucu oluşan, omuriliğe baskı yaparak akut nörolojik defisitlere yol açabilen nadir fakat ciddi bir klinik durumdur. Bu olgu sunumunda, bel ağrısı ve ilerleyici alt ekstremite güçsüzlüğü şikayetiyle başvuran 76 yaşındaki kadın hastada SEH tespit edilmiştir. Manyetik rezonans görüntüleme, spinal kordu komprese eden epidural hematomu ortaya koymuştur. Atriyal fibrilasyon nedeniyle rivaroksaban kullanmasına rağmen, koagülasyon anormalliği saptanmamıştır. Laminotomi ve hematom drenajı ile cerrahi müdahale yapılan hastada, nörolojik iyileşme sağlanmıştır. Bu olgu, SEH'nin yönetiminde erken tanı ve müdahalenin kalıcı nörolojik defisiti önlemede ve prognozu iyileştirmede önemini vurgulamaktadır. Ayrıca, mevcut literatürle karşılaştırılmalı olarak klinik bulgular ve tedavi yaklaşımları değerlendirilmektedir.
Spontaneous spinal epidural hematoma (SEH) is a rare but serious clinical condition characterized by the accumulation of blood in the spinal epidural space, often leading to acute neurological deficits due to spinal cord compression. This case report presents a 76-year-old female with lumbar pain and progressive lower limb weakness, diagnosed with SEH. Magnetic resonance imaging revealed an epidural hematoma compressing the spinal cord. Despite being on rivaroxaban for atrial fibrillation, no coagulation abnormalities were detected. Surgical intervention with laminotomy and hematoma evacuation led to significant neurological recovery. The case highlights the importance of early diagnosis and intervention in SEH management to prevent permanent neurological deficit and improve outcomes. This report also compares the clinical findings and treatment approaches with existing literature, providing insights into the optimal management of SEH.
Referanslar
Zhong W, Chen H, You C, Li J, Liu Y, Huang S. Spontaneous spinal epidural hematoma. J Clin Neurosci. 2011;18(11):1490-1494. doi:10.1016/j.jocn.2011.02.039
Hsieh CT, Chiang YH, Tang CT, Sun JM, Ju DT. Delayed traumatic thoracic spinal epidural hematoma: a case report and literature review. Am J Emerg Med. 2007;25(1):69-71. doi:10.1016/j.ajem.2006.05.033
Moriarty HK, O Cearbhaill R, Moriarty PD, Stanley E, Lawler LP, Kavanagh EC. MR imaging of spinal haematoma: a pictorial review. Br J Radiol. 2019;92(1095):20180532. doi:10.1259/bjr.20180532
Kim JH, Kang WY, Cho BS, Yi KS. A Potential Diagnostic Pitfall in the Differentiation of Hemorrhagic and Fatty Lesions Using Short Inversion Time Inversion Recovery: a Case Report. Investig Magn Reson Imaging. 2016 Sep;20(3):181-184. https://doi.org/10.13104/imri.2016.20.3.181
Matsui H, Imagama S, Ito Z, et al. Chronic spontaneous lumbar epidural hematoma simulating extradural spinal tumor: a case report. Nagoya J Med Sci. 2014;76(1-2):195-201.
Zhang B, Chen J, Zou N, et al. Spontaneous resolution and complete recovery of spontaneous cervical epidural hematoma: Report of two cases and literature review. Neurochirurgie. 2019;65(1):27-31. doi:10.1016/j.neuchi.2018.10.008
Liu Z, Jiao Q, Wang X. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. Clinical features of spontaneous spinal epidural hematoma and influential factors of its prognosis. Chinese Journal of Reparative and Reconstructive Surgery. 2007 May;21(5):468-472.
Referanslar
Zhong W, Chen H, You C, Li J, Liu Y, Huang S. Spontaneous spinal epidural hematoma. J Clin Neurosci. 2011;18(11):1490-1494. doi:10.1016/j.jocn.2011.02.039
Hsieh CT, Chiang YH, Tang CT, Sun JM, Ju DT. Delayed traumatic thoracic spinal epidural hematoma: a case report and literature review. Am J Emerg Med. 2007;25(1):69-71. doi:10.1016/j.ajem.2006.05.033
Moriarty HK, O Cearbhaill R, Moriarty PD, Stanley E, Lawler LP, Kavanagh EC. MR imaging of spinal haematoma: a pictorial review. Br J Radiol. 2019;92(1095):20180532. doi:10.1259/bjr.20180532
Kim JH, Kang WY, Cho BS, Yi KS. A Potential Diagnostic Pitfall in the Differentiation of Hemorrhagic and Fatty Lesions Using Short Inversion Time Inversion Recovery: a Case Report. Investig Magn Reson Imaging. 2016 Sep;20(3):181-184. https://doi.org/10.13104/imri.2016.20.3.181
Matsui H, Imagama S, Ito Z, et al. Chronic spontaneous lumbar epidural hematoma simulating extradural spinal tumor: a case report. Nagoya J Med Sci. 2014;76(1-2):195-201.
Zhang B, Chen J, Zou N, et al. Spontaneous resolution and complete recovery of spontaneous cervical epidural hematoma: Report of two cases and literature review. Neurochirurgie. 2019;65(1):27-31. doi:10.1016/j.neuchi.2018.10.008
Liu Z, Jiao Q, Wang X. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. Clinical features of spontaneous spinal epidural hematoma and influential factors of its prognosis. Chinese Journal of Reparative and Reconstructive Surgery. 2007 May;21(5):468-472.
