1/16. Spinal cord injury following an attempted thoracic epidural.Unsuccessful attempts were made to insert a thoracic epidural in an anaesthetised patient. Signs of spinal cord damage were observed the following day. magnetic resonance imaging demonstrated a haematoma anterior to the spinal cord. Surgical exploration revealed an intradural haematoma and a needle puncture of the cord. The patient suffered a permanent paraparesis.- - - - - - - - - - ranking = 1keywords = haematoma (Clic here for more details about this article) |
2/16. Lumbar ependymoma presenting with paraplegia following attempted spinal anaesthesia.Neurological deterioration from intraspinal haematoma following insertion of a spinal needle is extremely rare. We present the case of a 28-yr-old female, who presented with complete paraplegia following attempted spinal anaesthesia for delivery of her third child. Space-occupying iatrogenic spinal haemorrhage from a previously undiagnosed lumbar ependymoma was found to be the precipitating cause. Following laminotomy with blood clot and tumour removal her neurological function improved.- - - - - - - - - - ranking = 0.5keywords = haematoma (Clic here for more details about this article) |
3/16. Widespread post-traumatic acute spinal subdural haematoma: case report and review of the literature.STUDY DESIGN: A case report of acute post-traumatic spinal subdural haematoma (ASSH). OBJECTIVE: To report a rare post-traumatic problem. SETTING: Dicle University Hospital, Diyarbakir, turkey. METHOD: A 3-year-old boy was admitted to our clinic with paraplegia 24 h after falling from a height of about 5 meters. Investigation revealed an acute spinal subdural haematoma. RESULTS: Following surgery there was marked improvement. The rehabilitation of the patient continues. CONCLUSION: MRI is the most valuable diagnostic method. In each case diagnosed as ASSH, prompt evacuation should be performed before irreversible neurological damage occurs.- - - - - - - - - - ranking = 3keywords = haematoma (Clic here for more details about this article) |
4/16. Spinal subdural haematoma: how relevant is the INR?STUDY DESIGN: Case report. OBJECTIVE: To report a rare cause of spinal cord compression. SETTING: University Hospital, wales, UK. CASE REPORT: A 67-year-old gentleman on oral anticoagulation for atrial fibrillation presented with a 4-h history of progressive loss of sensation and weakness in both legs; there was no history of trauma. On examination, he had a flaccid paraplegia with altered sensation in the L1,2,3 dermatomes and complete anaesthesia in the L4,5 distribution. knee and ankle jerk reflexes were absent, plantars were equivocal and anal sphincter tone was reduced. The patient's international normalized ratio (INR) was 4.1. An MR scan showed an extensive intradural haematoma compressing the cauda equina. The anticoagulation was reversed and an urgent T12-L2 laminectomy was performed; findings were a circumferential haematoma at L1 extending in the anterior canal between T10 and L3. The patient had an uneventful postoperative course generally, but at 1 week there was no neurological recovery. CONCLUSION: This case highlights that anticoagulation even when well controlled is not without risk. This is particularly of concern as the number of patients receiving long-term anticoagulation therapy has doubled between 1993 and 1998.- - - - - - - - - - ranking = 3keywords = haematoma (Clic here for more details about this article) |
5/16. Pseudo-tumours of the urinary tract in patients with spinal cord injury/spina bifida.OBJECTIVE: To raise awareness of pseudo-tumours of urinary tract, as pseudo-tumours represent benign mass lesions simulating malignant neoplasms. Accurate diagnosis helps to avoid unnecessary surgery in spinal cord injury patients. SETTING: Regional spinal injuries Centre, Southport, UK case reports: Pseudo-tumour of kidney: A 58-year-old man with tetraplegia developed a right perirenal haematoma while taking warfarin; ultrasound and CT scanning showed no evidence of tumour in the right kidney. The haematoma was drained percutaneously. After 8 months, during investigation of a urine infection, ultrasound and CT scan revealed a space-occupying lesion in the mid-pole of the right kidney. CT-guided biopsy showed features suggestive of an organising haematoma; the lesion decreased in size over the next 13 months, thus supporting the diagnosis. Pseudo-tumour of urinary bladder: A frail, 34-year-old woman, who had spina bifida, marked spinal curvature and pelvic tilt, had been managing her neuropathic bladder with pads. She had recurrent vesical calculi and renal calculi. CT scan was performed, as CT would be the better means of evaluating the urinary tract in this patient with severe spinal deformity. CT scan showed a filling defect in the base of the bladder, and ultrasound revealed a sessile space-occupying lesion arising from the left bladder wall posteriorly. Flexible and, later, rigid cystoscopy and biopsy demonstrated necrotic slough and debris but no tumour. Ultrasound scan after 2 weeks showed a similar lesion, but ultrasound-guided biopsy was normal with nothing to explain the ultrasound appearances. A follow-up ultrasound scan about 7 weeks later again showed an echogenic mass, but the echogenic mass was seen to move from the left to the right side of the bladder on turning the patient, always maintaining a dependent position. The echogenic bladder mass thus represented a collection of debris, which had accumulated as a result of chronic retention of urine and physical immobility. CONCLUSION: Recognising the true, non-neoplastic nature of these lesions enabled us to avoid unnecessary surgical procedures in these patients, who were at high risk of surgical complications because of severely compromised cardiac and respiratory function.- - - - - - - - - - ranking = 1.5keywords = haematoma (Clic here for more details about this article) |
6/16. Spontaneous spinal epidural haematoma: report of two cases and review of the literature.The clinical presentation, investigation, management and outcome of two patients with spontaneous spinal epidural haematoma (SSEH) are presented. CT myelogram revealed an extradural compressive lesion in one patient and MRI confirmed extradural haemorrhage in the second. Both the cases were treated surgically. One patient made a complete recovery and the other made no neurological recovery. The clinical presentation, diagnosis, treatment and factors determining the outcome of SSEH are discussed and the literature reviewed.- - - - - - - - - - ranking = 2.5keywords = haematoma (Clic here for more details about this article) |
7/16. Huge epidural hematoma after surgery for spinal cord stimulation.OBJECTIVE AND IMPORTANCE: Spinal epidural haematoma (SEH) following implantation of an epidural spinal cord electrode is a very rare complication but one that must not be overlooked. This case is unusual because of the almost "holocord" extension of the haematoma and the excellent recovery obtained by prompt surgical treatment. CLINICAL PRESENTATION: A 69 years old man with normal serum coagulation parameters was submitted to spinal cord stimulation (SCS) for chronic pain syndrome. After a minimal L1 laminotomy the patient developed paraplegia due to a large haematoma at D4-L2. INTERVENTION: Surgical removal of the entire clot by a D4-L2 laminectomy was performed immediately. CONCLUSION: Large epidural haematoma can result from SCS and this complication may be cured by appropriate and prompt surgery.- - - - - - - - - - ranking = 2keywords = haematoma (Clic here for more details about this article) |
8/16. Spinal haematoma following epidural analgesia. Report of a patient with ankylosing spondylitis and a bleeding diathesis.A patient who developed an epidural haematoma with multifactorial aetiology (bleeding diathesis, ankylosing spondylitis, chronic alcoholism and acute pancreatitis) after epidural analgesia for pain relief is described. Our conclusion is that adequate laboratory screening of blood coagulation, including platelet count, should be carried out in this category of patient before attempted epidural blockade, the risks of which must be weighed against the benefits. The block should be allowed to wear off intermittently and repeated neurological assessment performed if an epidural catheter is used for repeated injections or for a continuous infusion of local anaesthetic. Neuroradiological examination should be carried out promptly if an epidural haematoma is suspected and surgical decompression performed without delay if the diagnosis is confirmed.- - - - - - - - - - ranking = 3keywords = haematoma (Clic here for more details about this article) |
9/16. Spontaneous dorsal epidural haematoma: usefulness of magnetic resonance imaging and importance of operative treatment even in cases with complete paraplegia.Spontaneous epidural haematomas are rare at any level of the spinal canal. The radiological diagnosis is usually made by myelography and in a few reported cases by computed tomography (CT). We describe a patient in which the final diagnosis was possible only with magnetic resonance imaging (MRI). Surgical evacuation resulted in partial recovery of an already four days existing complete paraplegia. It is stressed that MRI is the most useful examination to differentiate haematomas from other spinal epidural lesions and that an operative evacuation of a spinal epidural haematoma is indicated even if the patient comes after a complete paraplegia has developed.- - - - - - - - - - ranking = 3.5keywords = haematoma (Clic here for more details about this article) |
10/16. Spontaneous spinal subdural haematoma during general anaesthesia.Spontaneous spinal subdural haematoma causing acute spinal cord compression is a well recognized condition and often responds well to early surgical intervention. In the elderly, the haematoma usually occurs as a result of minor trauma or atherosclerosis with hypertension. We present in this report the history of a patient who became paraplegic during a general anaesthetic for an operation for removal of a ureteral calculus. rupture of a spinal vascular malformation was found to be responsible for the subdural haematoma, which remained undiagnosed until surgical exploration.- - - - - - - - - - ranking = 3.5keywords = haematoma (Clic here for more details about this article) |
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