Abstract
IntroductionSubarachnoid hemorrhages of spinal origin are extremely rare during pregnancy. We present the case of a patient with hemolytic anemia, elevated liver enzymes and low platelet count (the so-called HELLP syndrome), a potentially life-threatening complication associated with pre-eclampsia, who presented with an idiopathic spinal subarachnoid hematoma.Case presentationAt 29 gestational weeks, a 35-year-old Japanese woman was diagnosed with HELLP syndrome based on bilateral leg paralysis, diminished sensation and reflexes, and laboratory findings. The pregnancy was immediately brought to an end by Cesarean delivery. Post-operatively, an MRI scan revealed a space-occupying lesion in her thoracic spinal canal. Emergency decompression was followed by total laminectomy. A subarachnoid hematoma, partially extending as far as the ventral side, was removed. After thorough washing and drain placement, the operation was completed with the suturing of artificial dura mater. Eight months post-operatively, her lower extremity sensation had improved to a score of 8 out of 10, but improvements in her muscular strength were limited to slight gains in her toes. MRI scans taken two months post-operatively revealed edematous spinal cord changes within her medulla.ConclusionsA subarachnoid hematoma during pregnancy is extremely rare, possibly due to increased coagulability during pregnancy. However, this complication is potentially devastating should a clot compress the spinal cord or cauda equina. While several causes of hematoma have been proposed, we speculate that the factors underlying hemorrhagic diathesis in our case were the decreased platelet count characteristic of HELLP syndrome and vascular fragility due to elevated estrogen levels, in addition to increased abdominal pressure during pregnancy and pressure from the gravid uterus resulting in ruptured vessels around the spinal cord. In cases displaying a progressive lesion and severe neurological signs, prompt decompression is crucial.
Highlights
Subarachnoid hemorrhages of spinal origin are extremely rare during pregnancy
While several causes of hematoma have been proposed, we speculate that the factors underlying hemorrhagic diathesis in our case were the decreased platelet count characteristic of HELLP syndrome and vascular fragility due to elevated estrogen levels, in addition to increased abdominal pressure during pregnancy and pressure from the gravid uterus resulting in ruptured vessels around the spinal cord
We describe here a case of spinal subarachnoid hematoma associated with hemolytic anemia, elevated liver enzymes and low platelet count, a potentially life-threatening obstetric complication
Summary
A subarachnoid hematoma during pregnancy is extremely rare, probably due to increased coagulability. Clinicians need to be able to recognize the symptoms and signs of a spinal subarachnoid hematoma promptly, to avoid delays in treatment and severe neurological deficits. Consent Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Komiyama M, Yasui T, Sumimoto T, Fu Y: Spontaneous spinal subarachnoid hematoma of unknown pathogenesis: case reports. Doi:10.1186/1752-1947-6-152 Cite this article as: Fujimaki et al.: Spinal subarachnoid hematoma in a woman with HELLP syndrome: a case report. Journal of Medical Case Reports 2012 6:152
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