Yıl: 2015 Cilt: 32 Sayı: 1 Sayfa Aralığı: 231 - 236 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Management of Acute Non-Traumatic Intradural Spinal Hematoma Associated With Oral Anti-Coagulant and Anti-Aggregant Therapy: Case Report and Review of Literature

Öz:
Travmatik olmayan spinal hematomların çoğunluğu epidural hematomlar olup, literatürde %1'in altında rapor edilmiştir. İntradural spinal hematomlar ise daha da nadir saptanmaktadır.55 yaşında erkek; baş dönmesi, sol kol ve bacakta uyuşma şikayeti ile acil servisimizebaşvuran hasta İskemik Serebro vasküler olay tanısı ile Nöroloji Kliniği tedaviye alınmıştır.Yapılan muayenesinde sağ gözde yukarı ve aşağı bakışta horizantal nistagmus dışında pozitifbulgu yoktu. Sol serebellar hemisferde ve sol pariyeto-oksipital bölgede akut difüzyonkısıtlılığı ve sol ICA servikal segmentte disseksiyon saptanmıştır. Hastaya nöroloji kliniğinceantikoagülan ve antiagregan tedavi başlanmıştır. Tedavinin 5. günü ani başlayan bel ve sağbacak ağrısı nedeniyle çekilen Lomber MR'da L2-L5 arası intradural ve/veya epiduralhematom saptanmıştır(Figür 1-2). Motor duyu defisiti yoktu. Acil cerrahi girişimdüşünülmedi, antikoagülan ve antiagregan tedavilerinin kesilmesi ve immobilizasyonuönerildi. Takiplerinde her iki bacakta ani gelişen kuvvet kaybı nedeniyle tekrarlananTorakolomber MR'da T12-L5 düzeylerinde hematom izlendi. Nörolojik muayenede 2/5paraparazi saptanması üzerine acil ameliyata alındı (Figür 3-4). T11-T12-L1-L2-L3-L4 total,L5 bilateral superior osteotomi,T11-L5 duratomi ile T11-L5 arası intradural hematomboşaltıldı. T11-S1 posterior enstrümantasyon ve duraplasti yapıldı(Figür 5-6). Hasta post-op15. gününde bilateral +4/5 kas gücü ile taburcu edildi. Nontravmatik spinal intraduralhematomlar oldukça nadirdir ve oluştuklarında hızla spinal kord veya kauda equinakompresyonu ile ciddi nörolojik defisitlere yok açabilirler. Antikoagülan tedavi alanhastalarda gelişen bel ağrısı benzeri semptomlarda spinal kanamalar akıla getirilmeli, gereklimuayene ve tetkikler tamamlanmalıdır. Defisit gelişen hastalara erken dekompresif cerrahiönerilmektedir.
Anahtar Kelime:

Konular: Nörolojik Bilimler

Antikoagülan Tedavi Sonrası Gelişen Nontravmatik İntradural Spinal Hematom: Olgu Sunumu ve Literatürün Gözden Geçirilmesi

Öz:
Most of the non-traumatic spinal hematomas are epidural hematomas and reported less than1% in literature. Intra-dural non-traumatic spinal hematomas are even more rare pathologies.A 55-years-old man admitted with the complaints of vertigo and left hemi-hypoesthesia. MRIfindings revealed left cerebellar, left parieto-occipital diffusion restriction and dissection ofleft cervical segment of internal carotid artery and patient was treated with anticoagulant andanti-aggregant therapy. During anticoagulant and anti-aggregant therapy sudden onsetparaparasia with motor strength 2/5 was developed. Urgent throco-lumbar MRI revealedintra-dural acute hematoma at T12-L5 levels. The patient immediately underwentdecompressive T11-T12-L1-L2-L3-L4-L5 total laminectomy, intra-dural rigid hematomadrainage and posterior instrumentation with duraplasty. The patient was discharged withmotor strength 4/5 bilaterally on the 15th day of operation. To our knowledge present case isthe longest segmental intradural non-traumatic spinal hematoma in the literature thatunderwent decompressive and stabilization surgery. Non-traumatic spinal intraduralhematomas (NTSIDH) are extremely rare. Urgent decompressive surgery is gold standard forpatients with progressive neurologic deficits.
Anahtar Kelime:

Konular: Nörolojik Bilimler
Belge Türü: Makale Makale Türü: Olgu Sunumu Erişim Türü: Erişime Açık
  • 1. Akita K, Wada T, Horii S, Matsumoto M, Adachi T, Kimura F, Itoh K. : Acute spinal subdural hematoma in a patient with active systemic lupus erythematous : a case report and review of literature. Inter Med. 2014;53(8):887-90.
  • 2. Alpoim B, Rodrigues M, Silva P, Carvalho B, Pereira P, Vaz R. : Spontaneous spinal subdural hematoma. Acta Med Port. 2011 Dec;24 Suppl 3:725-8.
  • 3. Badge R, Chan D. :Spinal Subdural Haematoma in association with anticoagulant therapy, an unusual presentation: a case report and review of literature. Cases Journal 2009, 2:151.
  • 4. Bruce-Brand RA, Colleran GC, Broderick JM, Lui DF, Smith EM, Kavanagh EC, Poynton AR. Acute nontraumatic spinal intradural hematoma in a patient on warf arin. J Emerg Med. 2013 Nov;45(5);695-7.
  • 5. Cakirer S, Basak M, Galip GM. : Cervical hematomyelia secondary to oral anticoagulant therapy: case report. Neuroradiology 2001; 43: 1087–8.
  • 6. Calhoun JM, Boop F.: Spontaneous spinal subdural haematoma: Case report and review of the literature. Neurosurg 1991;29: 133-134.
  • 7. Cordan T, Bekar A, Yaman O, Tolunay S.: Spinal subarachnoid haemorrhage attributable to schwannoma of the cauda equina. Surg Neurol 1999; 51: 373-375.
  • 8. Domenicucci M, Ramieri A, Ciappetta P, Delf ini R. :Nontraumatic acute spinal subdural haematoma. J Neurosurg (Spine 1) 1999;91: 65-73.
  • 9. Gaitzsch J, Berney J. :Spinal subarachnoid haematoma of spontaneous origin and complicating anticoagulation. Surg Neurol 1984;21: 534-538.
  • 10. GuthikondaM, Schmidek HH, Wallman LJ, Snyder TM. : Spinal subdural haematoma: Case report and review of the literature. Neurosurg 1979; 5: 614- 616.
  • 11. Haj i Mohd Yasin NA, Donato-Brown D, Taha A. Non-traumatic spontaneous spinal subdural haematoma. N Z Med J. 2012 Oct 12;125(1363):77- 80.
  • 12. Hausmann O, Kirsch E, Radü E, Mindermann Th, Gratzl O. Coagulopathy Induced Spinal Intradural Extramedullary Haematoma: Report of Three Cases and Review of the Literature Acta Neurochir (Wien) 2001;143: 135-140.
  • 13. Kirazli Y, Akkoc Y, Kanyilmaz S: Spinal epidural hematoma associated with oral anticoagulation therapy. Am J Phys Med Rehabil 2004;83:220–223.
  • 14. Kobayashi Y, Nakada J, Kuroda H, Sakakura N, Usami N, Sakao Y. Spinal Epidural Hematoma during Anticoagulant Therapy f or Pulmonary Embolism: Postoperative Complications in a Patient with Lung Cancer . Ann Thorac Cardiovasc Surg 2014 Feb. doi: 10.5761/atcs.cr.13-00177.
  • 15. Martinez R, Vaquero J, Glisanz F. Spontaneous spinal subdural hematoma. Case report. J. Neurosurg Sci. 1987 Jul-Sep 31(3);157-8.
  • 16. Morandi X, Laurent R, Emmaneul C, et al.: Acute Nontraumatic Spinal Subdural Haematoma in Three Patients. Spine 2001 ;26:E547-551.
  • 17. Park J, Ahn R, Son D, Kang B, Yang D. Acute spinal subdural hematoma with hemiplegia af ter acapuncture: a case report and review of literature. Spine J. 2013 Oct;13(10):e59-63.
  • 18. Russel NA, Benoit BG.: Spinal subdural haematoma. A review. Surg Neurol. 1983; 20: 133-137.
  • 19. Schiller F, Neligan G, Budtz-Olsen O. : Surgery in haemophilia; a case of spinal subdural haematoma producing paraplegia. Lancet. 1948 Nov27;2(6535):842-5.
  • 20. Tomarken JL. Spinal subdural haematoma. A case report and literature review. Am J Emerg Med 1987; 5: 123-125.
  • 21. Tricot R, Nogrette P, Coumel P, Ragot M. : Subdural intraspinal hemorrhage, hemorrhage and spinal sof tening during anticoagulant treatment in a mitral disease patient. Bull Mem Soc Hop Paris. 1964 Apr 24;115:627-37.
  • 22. Vinters HV, Barnett HJ, Kauf mann JC. Subdural haematoma of the spinal cord and widesp read subarachnnoid haemorrhage complicating anticoagulation therapy. Stroke 1980; 11: 459-464.
  • 23. Wang US, Ju CI, Kim SW, Kim SH. Spontaneous Concomitant Intracranial and Spinal Subdural Hematomas in Association with Anticoagulation Therapy. J Korean Neurosurg Soc 2012; 51 : 237- 239.
APA Gurcay A, Gurcan O, KAZANCI A, GÖKER T, TURKOGLU F, BAVBEK M (2015). Management of Acute Non-Traumatic Intradural Spinal Hematoma Associated With Oral Anti-Coagulant and Anti-Aggregant Therapy: Case Report and Review of Literature. , 231 - 236.
Chicago Gurcay Ahmet Gurhan,Gurcan Oktay,KAZANCI Atilla,GÖKER Tuncer,TURKOGLU Faruk Omer,BAVBEK Murad Management of Acute Non-Traumatic Intradural Spinal Hematoma Associated With Oral Anti-Coagulant and Anti-Aggregant Therapy: Case Report and Review of Literature. (2015): 231 - 236.
MLA Gurcay Ahmet Gurhan,Gurcan Oktay,KAZANCI Atilla,GÖKER Tuncer,TURKOGLU Faruk Omer,BAVBEK Murad Management of Acute Non-Traumatic Intradural Spinal Hematoma Associated With Oral Anti-Coagulant and Anti-Aggregant Therapy: Case Report and Review of Literature. , 2015, ss.231 - 236.
AMA Gurcay A,Gurcan O,KAZANCI A,GÖKER T,TURKOGLU F,BAVBEK M Management of Acute Non-Traumatic Intradural Spinal Hematoma Associated With Oral Anti-Coagulant and Anti-Aggregant Therapy: Case Report and Review of Literature. . 2015; 231 - 236.
Vancouver Gurcay A,Gurcan O,KAZANCI A,GÖKER T,TURKOGLU F,BAVBEK M Management of Acute Non-Traumatic Intradural Spinal Hematoma Associated With Oral Anti-Coagulant and Anti-Aggregant Therapy: Case Report and Review of Literature. . 2015; 231 - 236.
IEEE Gurcay A,Gurcan O,KAZANCI A,GÖKER T,TURKOGLU F,BAVBEK M "Management of Acute Non-Traumatic Intradural Spinal Hematoma Associated With Oral Anti-Coagulant and Anti-Aggregant Therapy: Case Report and Review of Literature." , ss.231 - 236, 2015.
ISNAD Gurcay, Ahmet Gurhan vd. "Management of Acute Non-Traumatic Intradural Spinal Hematoma Associated With Oral Anti-Coagulant and Anti-Aggregant Therapy: Case Report and Review of Literature". (2015), 231-236.
APA Gurcay A, Gurcan O, KAZANCI A, GÖKER T, TURKOGLU F, BAVBEK M (2015). Management of Acute Non-Traumatic Intradural Spinal Hematoma Associated With Oral Anti-Coagulant and Anti-Aggregant Therapy: Case Report and Review of Literature. Journal of Neurological Sciences (Turkish), 32(1), 231 - 236.
Chicago Gurcay Ahmet Gurhan,Gurcan Oktay,KAZANCI Atilla,GÖKER Tuncer,TURKOGLU Faruk Omer,BAVBEK Murad Management of Acute Non-Traumatic Intradural Spinal Hematoma Associated With Oral Anti-Coagulant and Anti-Aggregant Therapy: Case Report and Review of Literature. Journal of Neurological Sciences (Turkish) 32, no.1 (2015): 231 - 236.
MLA Gurcay Ahmet Gurhan,Gurcan Oktay,KAZANCI Atilla,GÖKER Tuncer,TURKOGLU Faruk Omer,BAVBEK Murad Management of Acute Non-Traumatic Intradural Spinal Hematoma Associated With Oral Anti-Coagulant and Anti-Aggregant Therapy: Case Report and Review of Literature. Journal of Neurological Sciences (Turkish), vol.32, no.1, 2015, ss.231 - 236.
AMA Gurcay A,Gurcan O,KAZANCI A,GÖKER T,TURKOGLU F,BAVBEK M Management of Acute Non-Traumatic Intradural Spinal Hematoma Associated With Oral Anti-Coagulant and Anti-Aggregant Therapy: Case Report and Review of Literature. Journal of Neurological Sciences (Turkish). 2015; 32(1): 231 - 236.
Vancouver Gurcay A,Gurcan O,KAZANCI A,GÖKER T,TURKOGLU F,BAVBEK M Management of Acute Non-Traumatic Intradural Spinal Hematoma Associated With Oral Anti-Coagulant and Anti-Aggregant Therapy: Case Report and Review of Literature. Journal of Neurological Sciences (Turkish). 2015; 32(1): 231 - 236.
IEEE Gurcay A,Gurcan O,KAZANCI A,GÖKER T,TURKOGLU F,BAVBEK M "Management of Acute Non-Traumatic Intradural Spinal Hematoma Associated With Oral Anti-Coagulant and Anti-Aggregant Therapy: Case Report and Review of Literature." Journal of Neurological Sciences (Turkish), 32, ss.231 - 236, 2015.
ISNAD Gurcay, Ahmet Gurhan vd. "Management of Acute Non-Traumatic Intradural Spinal Hematoma Associated With Oral Anti-Coagulant and Anti-Aggregant Therapy: Case Report and Review of Literature". Journal of Neurological Sciences (Turkish) 32/1 (2015), 231-236.