Paraplegia caused by an epidural hematoma in a patient with unrecognized chronic idiopathic thrombocytopenic purpura following an epidural steroid injection.
METHODS
Case report.


OBJECTIVE
To report a rare case of complicated paraplegia caused by a spontaneous epidural hematoma following an epidural steroid injection in a patient with unrecognized chronic idiopathic thrombocytopenic purpura (ITP) and to review relevant literature and discuss etiology, pathogenesis, and clinical features.


BACKGROUND
A spinal epidural hematoma is a rare but potentially catastrophic complication, which could develop in patients without any risk factors. Some patients with chronic ITP are asymptomatic. To our knowledge there has been no previous report of such a complication.


METHODS
This is a retrospective review of a case seen at our institution.


RESULTS
The authors present a case of a 67-year-old woman who received an epidural steroid injection following complaints of lower back pain and bilateral buttock and leg pain. One day later, the patient had right leg numbness and weakness extending to her right knee; she was taken for emergency surgery. An emergency magnetic resonance imaging revealed an epidural hematoma with high-signal intensity on T2 imaging in the lumbar spinal cord and spinal cord compression with subdural hematoma. One week later, she was progressively developing lower extremity paraplegia with an L1 motor level and no sensory or sphincter activity. She was taken from the emergency room at our institution to the operating room for emergency decompression. After an uneventful course for 1 year, the patient presented with progressive bilateral lower extremity paralysis.


CONCLUSIONS
Epidural steroid therapy is a commonly used conservative therapy; however, complications could develop in patients without any risk factors. Clinicians who plan an epidural steroid injection must perform a rigorous evaluation through a detailed physical examination, simple laboratory tests, and history taking to prevent various risks associated with spinal cord compression.
Yoo
Hyung Seok
HS
Department of Anesthesiology and Pain Medicine, College of Medicine, Kyung Hee University, Seoul, Korea.
Park
Sung Wook
SW
Han
Jin Hee
JH
Chung
Jun Young
JY
Yi
Jae Woo
JW
Kang
Jong Man
JM
Lee
Bong Jae
BJ
Kim
Dong Ok
DO
D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects; D001778:Blood Coagulation Disorders / Q000150:complications / Q000175:diagnosis; D015984:Causality; D002908:Chronic Disease; D018450:Disease Progression; D004824:Epidural Space / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D046748:Hematoma, Epidural, Spinal / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D007268:Injections, Epidural / Q000009:adverse effects; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging; D010264:Paraplegia / Q000209:etiology*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications* / Q000175:diagnosis; D011859:Radiography; D012189:Retrospective Studies; D012585:Sciatica / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D013116:Spinal Cord / Q000000981:diagnostic imaging / Q000473:pathology; D013117:Spinal Cord Compression / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology*; D013256:Steroids / Q000008:administration & dosage / Q000009:adverse effects
D000893:Anti-Inflammatory Agents; D013256:Steroids