SHM Converge Scientific Abstract ePoster Gallery-Spontaneous Spinal Epidural Hematoma. A Rare Entity.

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This case report describes a rare spontaneous spinal epidural hematoma (SSEH) in a 72-year-old woman with coronary and peripheral vascular disease, as well as a remote stroke history, who developed sudden severe neck pain and paralysis after an outpatient femoral-popliteal bypass. During the procedure, she received intravenous heparin, and she had also been taking clopidogrel, last taken 24 hours earlier.<br /><br />On examination, she had profound neurological deficits, including loss of tone, power, and sensation in the upper extremities and severe weakness and sensory loss in the lower extremities. She also developed acute hypoxia and required intubation. Laboratory testing showed markedly elevated partial thromboplastin time, suggesting heparin effect. CT and MRI imaging revealed an extensive spinal epidural hematoma involving the thoracic and lumbar spine.<br /><br />After transfer to the MICU, the patient improved rapidly, was extubated, and follow-up MRI showed almost complete resolution of the hematoma. This suggests that conservative management may be appropriate in selected patients who show rapid neurological recovery, particularly when the hematoma is related to reversible anticoagulation.<br /><br />The discussion notes that heparin and clopidogrel are both associated with bleeding risk, but SSEH due solely to heparin is extremely uncommon unless another spinal procedure has occurred. The authors emphasize that only a few cases of clopidogrel- or enoxaparin-associated SSEH have been reported.<br /><br />The report concludes that SSEH is a neurosurgical emergency requiring immediate recognition. While urgent surgical decompression is usually the standard treatment, conservative management can be considered in patients who improve quickly. Clinicians should remain alert to this rare complication, especially in patients receiving anticoagulant or antiplatelet therapy.

Asset Subtitle

Syed Mohammad Mazhar Uddin

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Author List Aatera Haq, Arafat Farooqui, Daniel Masri, Omair Khan, Sanjay Maheshwari, Sanwal Singh Mehta, Sapna Kumari, Syed Mohammad Mazhar Uddin, Veronica Rozynek, William Pascal

Category Clinical Vignettes

Concept Spinal Hematoma

Concept Neurosurgical Emergency

Concept Neurologic Deficit

Concept Spinal Epidural Hematoma Diagnosis

Concept Procedural decompression

Distinguished Finalist

Presenter Organization Maimonides Medical Center

Presenting Author Syed Mohammad Mazhar Uddin

Track Adult

Keywords

spontaneous spinal epidural hematoma

SSEH

heparin

clopidogrel

anticoagulation

paralysis

neck pain

thoracic spine

lumbar spine

conservative management

Spinal Hematoma

Neurosurgical Emergency

Neurologic Deficit

Spinal Epidural Hematoma Diagnosis

Procedural decompression