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Vol 55, No 6 (2021)
Research Paper
Submitted: 2021-01-21
Accepted: 2021-05-25
Published online: 2021-10-12
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Spontaneous spinal epidural haematoma: management and main risk factors in era of anticoagulant / antiplatelet treatment

Ivana Stetkarova1, Edvard Ehler2, Karel Brabec1, Lenka Jelinkova1, Miroslava Chylova1, Jiri Weichet3, Leos Ungermann4, Tomas Peisker1
DOI: 10.5603/PJNNS.a2021.0066
·
Pubmed: 34637134
·
Neurol Neurochir Pol 2021;55(6):574-581.
Affiliations
  1. Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Czech Republic
  2. Neurological Department, Faculty of Health Studies, Pardubice University and Pardubice Regional Hospital, Czech Republic
  3. Department of Radiology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
  4. Department of Radiology, Faculty of Health Studies, Pardubice University and Pardubice Regional Hospital, Pardubice, Czech Republic

open access

Vol 55, No 6 (2021)
Research papers
Submitted: 2021-01-21
Accepted: 2021-05-25
Published online: 2021-10-12

Abstract

Aim of the study. Spontaneous spinal epidural haematomas (SSEH) are rare nosological units wherein acute collections of blood develop in the spinal canal. SSEH are usually manifested by sudden severe back pain accompanied by the development of neurological symptoms. In this study, we retrospectively describe management and the main risk factors of SSEH in a series of 14 cases. Material and methods. Between 2010 and 2019, we examined 14 patients (age range 17–89 years, 10 women) diagnosed with SSEH. Eight cases were patients using anticoagulant therapies (six warfarin, one dabigatran, one apixaban) and two others were using ASA of 100 mg/day. The exact localisation and extent of changes was determined from acute magnetic resonance imaging. Three people using warfarin had INR values higher than 3.0 at the time of their diagnosis. Results. Ten patients (71%) were taking oral anticoagulants or antiplatelet agents. In seven patients, SSEH were localised in the lower cervical/thoracic spine. Ten patients (71%) had arterial hypertension. Six patients underwent acute surgery due to rapidly developing spinal cord compression. Eight patients (57%) with slight or mild neurological symptoms were successfully managed without surgery. Conclusions. SSEH should be suspected in any patient receiving anticoagulant/antiplatelet agents who complains of sudden, severe back pain accompanied by neurological symptoms. SSEH is mostly localised in the lower cervical/thoracic spine. Arterial hypertension appears to be a risk factor of SSEH. Early decompression is an important therapeutic approach; in cases with minor neurological deficits, conservative treatment may be chosen.

Abstract

Aim of the study. Spontaneous spinal epidural haematomas (SSEH) are rare nosological units wherein acute collections of blood develop in the spinal canal. SSEH are usually manifested by sudden severe back pain accompanied by the development of neurological symptoms. In this study, we retrospectively describe management and the main risk factors of SSEH in a series of 14 cases. Material and methods. Between 2010 and 2019, we examined 14 patients (age range 17–89 years, 10 women) diagnosed with SSEH. Eight cases were patients using anticoagulant therapies (six warfarin, one dabigatran, one apixaban) and two others were using ASA of 100 mg/day. The exact localisation and extent of changes was determined from acute magnetic resonance imaging. Three people using warfarin had INR values higher than 3.0 at the time of their diagnosis. Results. Ten patients (71%) were taking oral anticoagulants or antiplatelet agents. In seven patients, SSEH were localised in the lower cervical/thoracic spine. Ten patients (71%) had arterial hypertension. Six patients underwent acute surgery due to rapidly developing spinal cord compression. Eight patients (57%) with slight or mild neurological symptoms were successfully managed without surgery. Conclusions. SSEH should be suspected in any patient receiving anticoagulant/antiplatelet agents who complains of sudden, severe back pain accompanied by neurological symptoms. SSEH is mostly localised in the lower cervical/thoracic spine. Arterial hypertension appears to be a risk factor of SSEH. Early decompression is an important therapeutic approach; in cases with minor neurological deficits, conservative treatment may be chosen.

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Keywords

spontaneous spinal epidural haematoma, spinal cord compression, anticoagulant therapy, surgical and non-surgical management, warfarin

About this article
Title

Spontaneous spinal epidural haematoma: management and main risk factors in era of anticoagulant / antiplatelet treatment

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 55, No 6 (2021)

Article type

Research Paper

Pages

574-581

Published online

2021-10-12

Page views

7665

Article views/downloads

785

DOI

10.5603/PJNNS.a2021.0066

Pubmed

34637134

Bibliographic record

Neurol Neurochir Pol 2021;55(6):574-581.

Keywords

spontaneous spinal epidural haematoma
spinal cord compression
anticoagulant therapy
surgical and non-surgical management
warfarin

Authors

Ivana Stetkarova
Edvard Ehler
Karel Brabec
Lenka Jelinkova
Miroslava Chylova
Jiri Weichet
Leos Ungermann
Tomas Peisker

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