Abstract
Spinal epidural hematoma has been a relatively rare condition. We recently encountered two cases of acute spinal epidural hematoma which developed during anticoagulant therapy. Case 1 was a 67-year-old woman who had been on oral aspirin and ticlopidine hydrochloride therapy for treatment of cerebral infarction. The woman developed pain in the lower back after rising one day. Paralysis of both extremities then developed and advanced rapidly. On first examination, complete paralysis of both extremities below the L2 level was noted, and MRI revealed spinal epidural hematoma at the Thll through L2 levels. Fresh platelet preparation was administered to improve the clotting system, and hematoma was evacuated surgically with a laminectomy. Her paralysis, however, remained unchanged after surgery. Case 2 was a 68-year-old woman who had been on oral warf arin therapy to treat atrialf ibrillation. She developed back pain suddenly, followed by paralysis of the left upper and lower extremities. The first examination noted complete paralysis below the C5 level on the left side (a sign of Brown-Sequard syndrome) . MRI disclosed epidural hematoma from the C2 through the Th2 levels. After treatment with vitamin K (a warf arin antagonist) to improve the clotting system, the patient underwent laminoplasty and evacuation of hematoma. As a result, muscle strength in the left upper and lower extremities improved to MMT 2, and she regained the ability to walk. It seems likely that idiopathic spinal epidural hematoma, caused by minute injury, was complicated by coagulation abnormalities, leading to intensification of the hematoma. Acute spinal epidural hematoma which has developed during anticoagurant therapy is unlikely to heal spontaneously. Early surgical treatment, combined with measures to improve the clotting function, seem effective.
