Spontaneous spinal epidural hematoma presenting as paraplegia after cardiac surgery.
An 86-year-old woman was scheduled to undergo aortic valve replacement and coronary artery bypass graft. On postoperative day 3, she developed sudden-onset neck pain followed by weakness in the right arm. Her symptoms worsened with time, and she developed paraplegia. At 60 h after the first complaint, spontaneous spinal epidural hematoma (SSEH) from C2 to C6 with spinal cord compression was diagnosed from a magnetic resonance image of the cervical region. We decided on conservative therapy because operative recovery was impossible. Delayed diagnosis led to grievous results in the present case. When neurological abnormalities follow neck or back pain after open heart surgery, SSEH must be considered in the differential diagnosis. Further, if it is suspected, early cervical computed tomography/magnetic resonance imaging and surgery should be considered.
Department of Cardiovascular Surgery, Iwate Medical University Memorial Heart Center, 19-1 Uchimaru, Morioka, 020-8505, Iwate, Japan. hkin@iwate-med.ac.jp.
Hajime
H
Kin
Department of Cardiovascular Surgery, Iwate Medical University Memorial Heart Center, 19-1 Uchimaru, Morioka, 020-8505, Iwate, Japan.
Masayuki
M
Mukaida
Department of Cardiovascular Surgery, Iwate Medical University Memorial Heart Center, 19-1 Uchimaru, Morioka, 020-8505, Iwate, Japan.
Junichi
J
Koizumi
Department of Cardiovascular Surgery, Iwate Medical University Memorial Heart Center, 19-1 Uchimaru, Morioka, 020-8505, Iwate, Japan.
Takeshi
T
Kamada
Department of Cardiovascular Surgery, Iwate Medical University Memorial Heart Center, 19-1 Uchimaru, Morioka, 020-8505, Iwate, Japan.
Yoshino
Y
Mitsunaga
Department of Cardiovascular Surgery, Iwate Medical University Memorial Heart Center, 19-1 Uchimaru, Morioka, 020-8505, Iwate, Japan.
Tomoyuki
T
Iwase
Department of Cardiovascular Surgery, Iwate Medical University Memorial Heart Center, 19-1 Uchimaru, Morioka, 020-8505, Iwate, Japan.
Akio
A
Ikai
Department of Cardiovascular Surgery, Iwate Medical University Memorial Heart Center, 19-1 Uchimaru, Morioka, 020-8505, Iwate, Japan.
Hitoshi
H
Okabayashi
D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003937:Diagnosis, Differential; D005260:Female; D046748:Hematoma, Epidural, Spinal / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D010264:Paraplegia / Q000175:diagnosis / Q000209:etiology*; D014057:Tomography, X-Ray Computed
Cardiac surgery; Magnetic resonance imaging; Paraplegia; Spinal epidural hematoma