Abstract
A 37-year-old female with acute spinal epidural hematoma (ASEH) who had undergone hemodialysis for twelve years is reported. She complained of neck and back pain just after starting hemodialysis and experienced lower paraplegia five hours later. She rapidly developed sensory disturbances below the Th4 level, quadriplegia and respiratory disturbances due to paralysis of the intercostal muscles. MRI examination revealed hematoma on the posterior side of the spinal epidural space from C3 to Th2. Under a diagnosis of ASEH, operation was performed ten hours after the onset. Laminotomy from C4 to Th3 and laminoplasty were performed. As an anticoagulant for postoperative hemodialysis, Nafamostat mesilate (Futhan®) 20mg/hr was used for the first seven days and heparin was subsequently used. Only paresis of the upper extremities improved. Other neurological deficits have remained. Moreover, endotracheal intubation and mechanical ventilation were temporarily indicated because the paralysis of the intercostal muscles led to atelectasis. Finally, tracheotomy was performed and she survived.
Only five cases, including ours, of ASEH in hemodialysis patients have been reported in the Japanese literature. Because of massive hematoma and systemic heparinization neurological recovery was poor and respiratory management was required in our case, although the interval between the onset and operation was brief. MRI examination was extremely helpful diagnostically and useful for making decisions regarding surgical treatment.
To achieve a better prognosis for ASEH, appropriate diagnosis and prompt treatment are indispensable and it is important to keep ASEH in mind in the management of hemodialysis patients.
