Recovery from acute paraplegia due to spontaneous spinal, epidural hematoma under minimal-dose acetyl-salicylic acid.
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.
Finsterer
Josef
J
Department of Neurology, Krankenanstalt Rudolfstiftung, Vienna, Austria. fifigs1@yahoo.de
Seywald
Stefanie
S
Stöllberger
Claudia
C
Krugluger
Walter
W
Tscherney
Robert
R
Ulram
Andreas
A
Kleinpeter
Günther
G
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
D010975:Platelet Aggregation Inhibitors; D001241:Aspirin