PDF(Pubmed)
Abstract：
BACKGROUND: Delayed spinal epidural hematoma (SEH) following central neuraxial block (CNB) is a rare but serious complication. The underlying causes of SEH associated with neuraxial anesthesia are still unclear. Furthermore, the decision between surgical intervention and conservative management for SEH remains a complex and unresolved issue.
METHODS: We report a case of delayed SEH in a 73-year-old woman who underwent vaginal hysterectomy under combined spinal-epidural anesthesia, with the administration of postoperative anticoagulants to prevent deep vein thrombosis on the 1st postoperative day (POD). She experienced symptoms 56 h after CNB. Magnetic resonance imaging (MRI) revealed a dorsal SEH at the L1-L4 level with compression of the thecal sac. On conservative treatment, full recovery was achieved after six months.
CONCLUSIONS: This case reminds anesthesiologists should be alert to the possible occurrence of a delayed SEH following CNB, particularly with the administration of anticoagulants. Immediate neurological evaluation of neurological deficit and MRI are advised. Conservative treatment combined with close and dynamic neurological function monitoring may be feasible for patients with mild or nonprogressive symptoms even spontaneous recovery.
METHODS: We report a case of delayed SEH in a 73-year-old woman who underwent vaginal hysterectomy under combined spinal-epidural anesthesia, with the administration of postoperative anticoagulants to prevent deep vein thrombosis on the 1st postoperative day (POD). She experienced symptoms 56 h after CNB. Magnetic resonance imaging (MRI) revealed a dorsal SEH at the L1-L4 level with compression of the thecal sac. On conservative treatment, full recovery was achieved after six months.
CONCLUSIONS: This case reminds anesthesiologists should be alert to the possible occurrence of a delayed SEH following CNB, particularly with the administration of anticoagulants. Immediate neurological evaluation of neurological deficit and MRI are advised. Conservative treatment combined with close and dynamic neurological function monitoring may be feasible for patients with mild or nonprogressive symptoms even spontaneous recovery.
摘要：
背景：中央神经轴阻滞（CNB）后迟发性硬膜外血肿（SEH）是一种罕见但严重的并发症。与神经轴麻醉相关的SEH的根本原因仍不清楚。此外，SEH手术干预和保守治疗之间的决定仍然是一个复杂且未解决的问题.
方法：我们报告一例在腰硬联合麻醉下接受阴式子宫切除术的73岁女性延迟SEH，在术后第一天（POD）给予术后抗凝剂以防止深静脉血栓形成。她在CNB后56小时出现症状。磁共振成像（MRI）显示L1-L4水平的背侧SEH，并压迫鞘囊。保守治疗,六个月后实现了完全康复。
结论：此病例提醒麻醉医师应警惕CNB后可能发生的SEH延迟，特别是抗凝剂的给药。建议立即对神经功能缺损和MRI进行神经系统评估。保守治疗结合密切和动态的神经功能监测可能是可行的，对于轻度或非进行性症状甚至自发恢复的患者。
方法：我们报告一例在腰硬联合麻醉下接受阴式子宫切除术的73岁女性延迟SEH，在术后第一天（POD）给予术后抗凝剂以防止深静脉血栓形成。她在CNB后56小时出现症状。磁共振成像（MRI）显示L1-L4水平的背侧SEH，并压迫鞘囊。保守治疗,六个月后实现了完全康复。
结论：此病例提醒麻醉医师应警惕CNB后可能发生的SEH延迟，特别是抗凝剂的给药。建议立即对神经功能缺损和MRI进行神经系统评估。保守治疗结合密切和动态的神经功能监测可能是可行的，对于轻度或非进行性症状甚至自发恢复的患者。
