title: Recovery from acute paraplegia due to spontaneous spinal, epidural hematoma under minimal-dose acetyl-salicylic acid.
abstract: OBJECTIVE
  Spontaneous spinal epidural hematoma (SEH) has not been reported under anti-thrombotic therapy with acetyl-salicylic acid (ASA) in a dosage of 50 mg/d.
  
  
  METHODS
  Spinal MRI, emergency laminectomy.
  
  
  RESULTS
  A 77-yo, HIV-negative female under longterm treatment over three years with ASA 50 mg/d for varicositas, prescribed by her general practitioner, experienced sudden onset back pain with radiation towards both knees after getting up in the morning. One-and-a-half hours later she also developed ascending hypesthesia and weakness originating from both distal lower limbs. Three hours after onset, hypesthesia had reached the T10-level bilaterally and she had become paraplegic. There was reduced intestinal motility, stool incontinence, and urinary hesitancy. MRI of the thoraco-lumbar spine demonstrated a SEH T9-L1 indenting the dural sack and compressing the myelon. Immediately after emergency laminectomy T10-12 with micro-surgical evacuation of the clot, 12 h after onset, she could move both legs again and was able to walk with support 7 days after surgery.
  
  
  CONCLUSIONS
  This case shows that SEH occurs under a minimal dose of ASA and that such patients rapidly recover upon immediate surgical decompression and evacuation of the hematoma.
authors.affiliation: Department of Neurology, Krankenanstalt Rudolfstiftung, Vienna, Austria. fifigs1@yahoo.de
authors.forename: Josef
authors.initials: J
authors.lastname: Finsterer
authors.forename: Stefanie
authors.initials: S
authors.lastname: Seywald
authors.forename: Claudia
authors.initials: C
authors.lastname: Stöllberger
authors.forename: Walter
authors.initials: W
authors.lastname: Krugluger
authors.forename: Robert
authors.initials: R
authors.lastname: Tscherney
authors.forename: Andreas
authors.initials: A
authors.lastname: Ulram
authors.forename: Günther
authors.initials: G
authors.lastname: Kleinpeter
mesh_terms: D000368:Aged; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects*; D001416:Back Pain / Q000209:etiology; D019299:Decompression, Surgical; D004305:Dose-Response Relationship, Drug; D004824:Epidural Space / Q000473:pathology / Q000601:surgery; D005260:Female; D046748:Hematoma, Epidural, Spinal / Q000139:chemically induced* / Q000150:complications* / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D019635:Neurosurgical Procedures; D010264:Paraplegia / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D020127:Recovery of Function; D012678:Sensation Disorders / Q000209:etiology; D013115:Spinal Canal / Q000473:pathology / Q000601:surgery; D013117:Spinal Cord Compression / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D013904:Thoracic Vertebrae / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D014648:Varicose Veins / Q000188:drug therapy
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin