title: Spontaneous spinal epidural hematoma associated with thrombolysis and anticoagulation therapy: report of three cases.
abstract: Three patients with a spontaneous spinal epidural hematoma are presented, one of which is exceptional because it could be attributed to thrombolysis with alteplase. The other two were correlated with oral anticoagulant therapy. Our second case suggests that Morbus Kahler may be an underlying pathology in spinal extradural hematoma. In the third patient neither an obvious 'locus minoris resistentiae' nor a pathological coagulation test could be held responsible for the spontaneous bleeding. All three patients underwent laminectomy and evacuation of the hematoma. Although two of our cases are examples of complete recuperation after late operative intervention, early surgery is preferable. Permanent clinical attention together with a low threshold to perform magnetic resonance imaging (MRI) leads to a quicker diagnosis of spinal epidural hematoma. We show that administration of gadolinium may facilitate correct preoperative localization of the hematoma because there may be contrast enhancement of the hematoma. Finally, the postoperative policy concerning thromboembolic prophylaxis is discussed.
authors.affiliation: Department of Neurosurgery, University Hospital Leuven, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Van Schaeybroeck
authors.forename: F
authors.initials: F
authors.lastname: Van Calenbergh
authors.forename: F
authors.initials: F
authors.lastname: Van De Werf
authors.forename: P
authors.initials: P
authors.lastname: Demaerel
authors.forename: J
authors.initials: J
authors.lastname: Goffin
authors.forename: C
authors.initials: C
authors.lastname: Plets
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D003937:Diagnosis, Differential; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D005682:Gadolinium; D006407:Hematoma, Epidural, Cranial / Q000139:chemically induced* / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D005682:Gadolinium; D010959:Tissue Plasminogen Activator