1/6. Use of topically applied rt-PA in the evacuation of extensive acute spinal subdural haematoma.Spontaneous spinal subdural haematoma is a rare cause of spinal cord compression, usually confined to a few vertebral levels. When the haematoma extends over several spinal segments, surgical decompression is a major undertaking. Recombinant tissue plasminogen activator (rt-PA) has previously been used in a number of surgical procedures, but not in the setting of acute spinal subdural haematoma. A minimally invasive technique of decompression, using topical rt-PA, is presented in two patients with extensive spinal intradural haematoma. Two patients receiving long-term anticoagulation therapy presented with acute-onset back pain progressing to paraparesis. magnetic resonance imaging of the spine demonstrated spinal subdural haematomas extending over 15 vertebral levels in one patient and 12 in the other. An angiography catheter was introduced into the subdural space through a limited laminectomy. Thrombolysis and evacuation of haematoma was then achieved by intermittent irrigation of the subdural space with rt-PA, followed by saline lavage. Postoperative imaging demonstrated satisfactory decompression in both patients. There was significant improvement of neurological function in one patient. Topical application of rt-PA for spinal subdural haematoma allows evacuation of the haematoma through a limited surgical exposure. decompression of the subdural space by this minimally invasive technique may be advantageous over extensive surgery by minimising surgical exposure, reducing postoperative pain and risk of neuronal injury. This technique may be useful in patients presenting with compression extending over several vertebral levels or poor surgical candidates.- - - - - - - - - - ranking = 1keywords = back pain, pain (Clic here for more details about this article) |
2/6. paraplegia due to spinal subdural hematoma as a complication of posterior fossa surgery: Case report and review of the literature.Although blood contamination of cerebrospinal fluid (CSF) after an intracranial operation is possible, development of a symptomatic spinal hematoma after a posterior fossa surgery has never been reported. A 43-year-old woman underwent a posterior fossa tumor removal in the prone position with no intraoperative difficulty. On the second postoperative day, she complained of severe epigastric pain and developed a rapid onset of paraplegia with anesthesia below the thoracic 5 spinal level. The emergency cranial and spinal MRIs revealed a spinal extramedullary hemorrhage spreading to the whole spinal regions, just sparing the cauda equina area. There was a prominent localized hematoma formation surrounding and compressing the spinal cord at the upper thoracic levels, which was evacuated via an urgent laminectomy. The patient showed partial neurological recovery after the decompression. Development of the spinal hematoma was explained by the movement of blood from the tumor bed into the spinal canal under the effect of gravity, during or after the operation. A 30 degrees head elevation might facilitate the accumulation of blood. Localization of the hematoma formation may be caused by the fact that the upper thoracic levels constitute the apex of the kyphosis. We conclusively suggest that a spinal hematoma should be taken into consideration as a rare but potentially severe complication of a posterior fossa surgery. Meticulous hemostasis and isolation of the surgical area from the spinal spaces are essential. Overdrainage of CSF should be abandoned. Postoperatively, patients should be monitored for spinal findings as well as cranial signs.- - - - - - - - - - ranking = 0.01480889417362keywords = pain (Clic here for more details about this article) |
3/6. Ruptured aneurysm of the posterior spinal artery of the conus medullaris.A case of a posterior spinal artery aneurysm of the conus medullaris is presented. The patient presented with severe lower back pain with radiation into the right leg. Spinal angiography was consistent with a partially thrombosed arteriovenous malformation (AVM) or an aneurysm. At operation a partially thrombosed aneurysm of the posterior spinal artery was found at the level of conus medullaris, which, after review of the literature, is the first case treated with total microsurgical excision.- - - - - - - - - - ranking = 0.98519110582638keywords = back pain, pain (Clic here for more details about this article) |
4/6. Subacute spinal subdural hematoma associated with intracranial subdural hematoma.We describe a subacute spinal subdural hematoma in a patient with psot-traumatic subacute intracranial subdural hematoma. CT and MRI demonstrated hematoma within the interhemispheric subdural space and at the lumbar posterior subdural space which extended from the L1 to the S2 level. The lesion showed high signal intensity on both T1 and T2 weighted images. Surgical decompression of the spinal subdural hematoma was performed. The symptoms completely resolved after surgery. Spinal subdural hematoma may be concomitant with or may occur after intracranial subdural hematoma. If a patient with intracranial subdural hematoma complains of low back pain and weakness in both legs; lumbosacral MR examination should be performed to exclude spinal subdural hematoma.- - - - - - - - - - ranking = 0.98519110582638keywords = back pain, pain (Clic here for more details about this article) |
5/6. Spinal chronic subdural hematoma in association with anticoagulant therapy: a case report and literature review.STUDY DESIGN: A case of spinal chronic subdural hematoma (SCSDH) in association with anticoagulant therapy was treated surgically. OBJECTIVE: To clarify the etiopathogenesis, clinical presentation, and surgical outcomes of SCSDH. SUMMARY OF BACKGROUND DATA: Intracranial chronic subdural hematoma is a well-recognized complication of anticoagulant therapy. However, SCSDH is very rare and its etiopathogenesis is uncertain. methods: A 72-year-old man with SCSDH who had received anticoagulant therapy for atrial fibrillation complained of bilateral lower extremity pain, cramps, and gait disturbance. The patient underwent an operation for evacuation of the hematoma. RESULTS: Lower-extremity pain, cramps, and gait disturbance improved, and the patient was discharged 10 days after surgery. CONCLUSION: SCSDH should be included in the differential diagnosis of progressive spinal cord and nerve root compression in patients receiving anticoagulant therapy. Prompt diagnosis and early surgical decompression lead to a good outcome.- - - - - - - - - - ranking = 0.029617788347241keywords = pain (Clic here for more details about this article) |
6/6. Subdural spinal haematoma after epidural anaesthesia in a patient with spinal canal stenosis.A 60-year-old male with a past history of T12 fracture had epidural analgesia for a radical prostatectomy. It was unknown prior to epidural insertion that the patient had a canal stenosis at T12 from the previous injury. The patient developed severe bilateral buttock pain after epidural catheter removal. magnetic resonance imaging demonstrated a spinal subdural haematoma from T10 to L2 with mild cord compression. The patient made a successful recovery with conservative management. Neuraxial blockade should be approached with caution in patients with previous back injury, and only after a thorough assessment has been obtained to exclude spinal canal stenosis.- - - - - - - - - - ranking = 0.01480889417362keywords = pain (Clic here for more details about this article) |