title: Recognition of a Thoracic Epidural Hematoma in the Setting of Transient Paralysis: A Case Report.
abstract: A 71-year-old woman on aspirin presented for a distal pancreatectomy, splenectomy, and partial colectomy with a T8/9 epidural catheter placed preoperatively in 3 attempts. Prophylactic 5000 units of subcutaneous heparin were given before the procedure. After catheter removal on postoperative day 2, the patient developed transient bilateral lower extremity paralysis, with near complete recovery within 30 minutes. An urgent MRI revealed a T4-T8 epidural hematoma prompting an emergent T3-T8 laminectomy. This case presentation highlights the need for heightened awareness regarding complications related to neuraxial analgesia in patients receiving unfractionated heparin for thromboembolism prophylaxis with concurrent aspirin use.
authors.affiliation: From the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Beth
authors.initials: B
authors.lastname: VanderWielen
authors.forename: Lindsay
authors.initials: L
authors.lastname: Rubenstein
authors.forename: Marc
authors.initials: M
authors.lastname: Shnider
authors.forename: Cindy
authors.initials: C
authors.lastname: Ku
authors.forename: Jason
authors.initials: J
authors.lastname: Wakakuwa
mesh_terms: D000368:Aged; D000767:Anesthesia, Epidural / Q000009:adverse effects* / Q000295:instrumentation; D000925:Anticoagulants / Q000009:adverse effects; D002408:Catheters, Indwelling; D020878:Device Removal; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects; D046748:Hematoma, Epidural, Spinal / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D006801:Humans; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D010243:Paralysis / Q000175:diagnosis / Q000209:etiology*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D011237:Predictive Value of Tests; D012307:Risk Factors; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors