PDF(Pubmed)
Abstract：
BACKGROUND: Spontaneous spinal epidural hematoma (SSEH) is a rare finding, but one with serious clinical implications. Oral anticoagulant drugs are known to be associated with the SSEH onset, particularly when combined with drugs increasing the bleeding risk.
METHODS: We present the case of a 62-year-old female on acencoumarol for her atrial fibrillation complicating severe mitral stenosis with a history of Ketoprofen use for the onset of her first symptoms. She presented to our emergency room with paraplegia and sphincter disturbance. Spinal magnetic resonance imaging (MRI) revealed a posterior SSEH extended from T10 to T12 requiring an urgent decompression of the spinal cord by laminectomy performed within 48 hours from the symptom\'s onset. After 3 months of rehabilitation, the patient improves partially her muscular strength with mostly unchanged sensitive and sphincteric levels.
UNASSIGNED: Vitamin K antagonists (VKA) use appears to be a high suspicion index for SSEH diagnosis resulting in earlier surgery and improving neurological outcome. Also, it is important to pay attention to the concomitant use of VKA and non-steroidal anti-inflammatory drugs which increase the risk of bleeding and may worsen the neurological outcome.
CONCLUSIONS: SSEH is a rare and serious finding which should be especially searched when a history of oral anticoagulation is reported in presence of neurological symptoms. A prompt and suitable management may improve the patient outcomes.
METHODS: We present the case of a 62-year-old female on acencoumarol for her atrial fibrillation complicating severe mitral stenosis with a history of Ketoprofen use for the onset of her first symptoms. She presented to our emergency room with paraplegia and sphincter disturbance. Spinal magnetic resonance imaging (MRI) revealed a posterior SSEH extended from T10 to T12 requiring an urgent decompression of the spinal cord by laminectomy performed within 48 hours from the symptom\'s onset. After 3 months of rehabilitation, the patient improves partially her muscular strength with mostly unchanged sensitive and sphincteric levels.
UNASSIGNED: Vitamin K antagonists (VKA) use appears to be a high suspicion index for SSEH diagnosis resulting in earlier surgery and improving neurological outcome. Also, it is important to pay attention to the concomitant use of VKA and non-steroidal anti-inflammatory drugs which increase the risk of bleeding and may worsen the neurological outcome.
CONCLUSIONS: SSEH is a rare and serious finding which should be especially searched when a history of oral anticoagulation is reported in presence of neurological symptoms. A prompt and suitable management may improve the patient outcomes.
摘要：
背景：自发性脊髓硬膜外血肿（SSEH）是一种罕见的发现，但有严重的临床意义。已知口服抗凝药物与SSEH发病有关，特别是与增加出血风险的药物联合使用时。
方法：我们介绍了一名62岁女性因房颤合并严重二尖瓣狭窄而出现首次症状时使用酮洛芬的病例。她带着截瘫和括约肌紊乱来到我们的急诊室。脊柱磁共振成像（MRI）显示，后部SSEH从T10扩展到T12，需要在症状发作后48小时内通过椎板切除术对脊髓进行紧急减压。经过3个月的康复，患者的部分肌肉力量得到改善，敏感性和括约肌水平基本不变。
■维生素K拮抗剂（VKA）的使用似乎是SSEH诊断的高度怀疑指标，可导致早期手术和改善神经系统预后。此外，重要的是要注意同时使用VKA和非甾体类抗炎药，这增加了出血的风险，并可能使神经系统结局恶化。
结论：SSEH是一种罕见且严重的发现，当报告存在神经系统症状的口服抗凝病史时，应特别进行搜索。及时和适当的管理可以改善患者的预后。
方法：我们介绍了一名62岁女性因房颤合并严重二尖瓣狭窄而出现首次症状时使用酮洛芬的病例。她带着截瘫和括约肌紊乱来到我们的急诊室。脊柱磁共振成像（MRI）显示，后部SSEH从T10扩展到T12，需要在症状发作后48小时内通过椎板切除术对脊髓进行紧急减压。经过3个月的康复，患者的部分肌肉力量得到改善，敏感性和括约肌水平基本不变。
■维生素K拮抗剂（VKA）的使用似乎是SSEH诊断的高度怀疑指标，可导致早期手术和改善神经系统预后。此外，重要的是要注意同时使用VKA和非甾体类抗炎药，这增加了出血的风险，并可能使神经系统结局恶化。
结论：SSEH是一种罕见且严重的发现，当报告存在神经系统症状的口服抗凝病史时，应特别进行搜索。及时和适当的管理可以改善患者的预后。
