Article
Rare cause of low back pain, late diagnosis, long rehabilitation – case report
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Published: | April 16, 2019 |
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Outline
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Background: In all patients who receive anticoagulant therapy there is always a risk for bleeding.
Aim: Authors report the case history of a 66-year-old woman, who became paraparetic because of a rare reason of acute low back pain.
Method: This patient was entered to a rheumatic ward due to low back pain and atypical numbness of lower extremities. Her symptoms deteriorated to severe paraparesis.
She had got anticoagulant therapy because of artificial aortic valve. At the admission to hospital her INR was 3,9. After rapid progression of paraparesis MRI showed an intraspinal bleeding in the altitude of ThX-LV. It was evacuated. After the operation the muscle strength improved around hip and knee, but plegia was still present in both ankles. In addition, the patient had hypaesthesia on the field of radices Th12-L5, anaesthesia of S1-5 also faecal and urinal incontinence.
At the admission to the rehabilitation ward the patient could sit up in the bed, and had static balance, but could not stand. Transfer to the wheelchair was not possible.
During physiotherapy she made muscle strengthening, practiced transfer to the wheelchair, making exercises for preparing walking and stair climbing.
Results/findings: At discharge she could walk alone 40–50 meters with rollator, for longer distances she needed a wheel chair. She could climb up 40 stairs holding the shackle. Because of urinal incontinence she was educated to execute intermittant catheterisation.
Discussion and conclusions: In conclusion it must be emphasized that in patients receiving anticoagulant therapy, low back pain can arise from haematoma and the quick diagnose can improve the outcome of rehabilitation.
References
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