Nonsurgical Intervention in a Preeclamptic Patient with Spontaneous Spinal Epidural Hematoma.

Antonio Liu,Michelle Nguyen,Maria Raquel Kronen,Alex Nhan

doi:10.1155/2018/5879481

Abstract

Background Spontaneous epidural hematoma (SEH) is a rare finding in pregnancy, especially since most pregnant women do not have risk factors for developing SEH. The presence of epidural anesthesia can delay the diagnosis of SEH in pregnant patients. Immediate surgical decompression is the current standard of care for treating SEH. Case Presentation We present the case of a 37-year-old pregnant woman with preeclampsia with severe features who developed neurological deficits that were initially attributed to her epidural anesthesia. She was eventually found to have SEH with spinal stenosis at T5-T6 on MRI. Oral antihypertensives were used to keep the patient's blood pressures within normal limits, and she subsequently had complete resolution of her neurological symptoms and her SEH on imaging. Conclusion Preeclampsia may contribute to the development of SEH in pregnancy, and strict blood pressure control may potentially provide a safe and effective alternative to neurosurgery for these patients.

Highlights

Spontaneous epidural hematoma (SEH) is a rare and devastating complication in the peripartum period
SEH in pregnant patients may remain undetected for a significant amount of time as these patients are less likely to have predisposing factors for SEH, such as anticoagulation, arteriovenous (AV) malformations, hemophilia, or trauma [1]
Maintaining the perfusion pressure of the spinal cord is important because decreased blood pressure can lead to decreased spinal cord blood flow, which could further compromise the segment of spinal cord that has already been injured by the spontaneous hemorrhage [15, 16]

Summary

Background

Spontaneous epidural hematoma (SEH) is a rare finding in pregnancy, especially since most pregnant women do not have risk factors for developing SEH. The presence of epidural anesthesia can delay the diagnosis of SEH in pregnant patients. We present the case of a 37year-old pregnant woman with preeclampsia with severe features who developed neurological deficits that were initially attributed to her epidural anesthesia. She was eventually found to have SEH with spinal stenosis at T5-T6 on MRI. Oral antihypertensives were used to keep the patient’s blood pressures within normal limits, and she subsequently had complete resolution of her neurological symptoms and her SEH on imaging. Preeclampsia may contribute to the development of SEH in pregnancy, and strict blood pressure control may potentially provide a safe and effective alternative to neurosurgery for these patients

Introduction

Case Report

Discussion

Conclusion