Spinal Subdural Hematoma in a Young Adult with Hemophilia A: A Case Report

Chunjiang Yan,Xiaoxin Wu,Guorong Liang,Ruifeng Zeng,Huanmei Li,Ye Ye

doi:10.11648/j.cmr.20200903.14

Abstract

Hemophilia is a set of hereditary hemorrhagic disorders of coagulation-dysfunction that can cause repeated bleeding in various tissues and organs. And the patient can be disabled due to bleeding from bones, joints, and soft tissue, or die due to splenic rupture or intracranial bleeding. So it is crucial to detect the site of bleeding in hemophilia patients quickly. Spontaneous spinal canal hematoma is a rare complication of hemophilia, with less than 50 cases reported to date. It can be easily missed and cause serious harm to patients. Hematoma, if untreated, causes irreversible nerve damage by compression of the spinal cord. Early recognition and treatment are most useful to prevent spontaneous spinal canal hematoma. We describe the case of a 21-year-old man with severe lumbago for two days, who had hemophilia A for a decade. The patient was diagnosed with spinal subdural hematoma by magnetic resonance imaging (MRI) after ruling out other causes of lumbago and treated with drugs by a neurologist. The hematoma showed absorption by MRI after six months. In conclusion, spontaneous spinal canal hematoma is a severe complication of hemophilia, which is often missed. This successful case confirms the importance of early diagnosis and treatment of spontaneous spinal canal hematoma. We hope to increase the clinicians’ vigilance of this disease.

Highlights

Hemophilia is a set of hereditary hemorrhagic disorders of coagulation-dysfunction
Friday [5] reported a case of spontaneous spinal subdural hematoma with hemophilia and cerebral palsy, which is similar to this report
As the backache gradually improved, the patient was discharged on September 12. He was reviewed by lumbar magnetic resonance imaging (MRI) without backache symptom on April 24, 2013, which showed a decrease in lumbar signal, combined with a history of hemophilia and abnormal signals in L1-5 level of the spinal canal, conforming to chronic hematoma absorption [Figure 2]

Summary

Introduction

Hemophilia is a set of hereditary hemorrhagic disorders of coagulation-dysfunction. It can generally be divided into two types. While spontaneous spinal canal subdural or epidural hematoma is common, a subarachnoid hematoma is rare because it usually cannot form hematomas [6]. The etiology of spontaneous spinal epidural hematoma is trauma, including accidents and iatrogenic causes, such as an epidural catheter, blood coagulation dysfunction, anticoagulation, arteriovenous malformation, spinal canal hemangioma, Paget’s disease [9, 10], but 40-50% have unknown etiology [11]. As the backache gradually improved, the patient was discharged on September 12 He was reviewed by lumbar MRI without backache symptom on April 24, 2013, which showed a decrease in lumbar signal, combined with a history of hemophilia and abnormal signals in L1-5 level of the spinal canal, conforming to chronic hematoma absorption [Figure 2]

Case Presentation

Discussion

Conclusions