Artikel
Spontaneous spinal epidural hematoma during anticoagulant therapy in older patients
Spontane epidurale spinale Hämatome unter Antikoagulation bei älteren Patienten
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Autoren
Veröffentlicht: | 23. April 2004 |
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Gliederung
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Objective
Spontaneous spinal epidural hematoma is a rare entity. We report six cases treated surgically for spontanous spinal epidural hematoma during anticoagulant therapy im older patients.
Methods
Attention was focused on sex, age, medical history, anticoagulation, size and position of the hematoma, vertebral level of the hematoma, preoperative neurological condition, operative interval, and outcome.
Results
This study comprised six patients, two females and four males, between 64 and 84 years old (mean, 74 years). In all cases, the cause was dertermined to be an acquired coagulopathy (4 x acetylsalicylacid and 2 x dicumarol therapies). Pain was the predominant initial symptom, and all patients developed neurological deficits. The segmental distribution revealed cervicothoracic and thoracolumbar areas predominated. The average interval from onset of symptoms to surgery was 14 hours (5-24 hours). Three patients had complete motor and sensory loss (Frankel grade A); and three had incomplete loss of motor function (Frankel grade C). Complete recovery (Frankel grade E) was observed in three patients and functional recovery was observed in two patients (one case Frankel grade D and one case Frankel grade C). One patient remained unchanged after operation (Frankel grade A).
Conclusions
The critical factors for recovery after spontaneous spinal epidural hematoma are level of preoperative neurological deficit. However, older patients with complete neurological leasions and cardiovascular diseases can improve substantially with surgery.