Spontaneous Spinal Hemorrhage Research Articles

Spontaneous spinal hemorrhage as the complication of low-molecular-weight heparin: A case report

A 57-year-old woman with good past health presented with sudden-onset paraplegia after receiving aspirin, clopidogrel, and low-molecular-weight heparin (LMWH) for suspected acute coronary syndrome. She suffered from spontaneous spinal hemorrhage which was intradural in location. She remained paraplegic despite clot evacuation and 2 months of rehabilitation. Caution on uncommon sites of bleeding should be taken when prescribing anti-thrombotic drugs. Of note, spontaneous spinal hemorrhage is one of the black box warnings of LMWH.

Usefulness of Surgical Diagnosis and Treatment of Spinal Cord Injury Caused by Epidural Spinal Arteriovenous Malformation Rupture: A Case Report of an Extremely Rare Disease

Spinal arteriovenous malformation (AVM) can cause spontaneous spinal hemorrhage. It is a rare disease that is difficult to diagnose because of technical difficulties in performing angiography and the small lesion size. To date, the most appropriate method of treating and diagnosing spontaneous spinal hemorrhage due to spinal AVMs with neurological deficits remains unclear. Herein, we present a rare case of spontaneous vertebral hemorrhage due to a thoracic epidural spinal AVM, which was removed surgically and accurately diagnosed based on a histopathological examination of the lesion. This case emphasizes that an accurate diagnosis and neurological recovery could be achieved in patients with spontaneous spinal epidural hematoma through biopsy and surgical removal of the hematoma and AVM.

Rare Presentations of Spontaneous Spinal Epidural Hematomas in Children.

ABSTRACTSpontaneous spinal epidural hematomas are a rare presentation in children with very few case reports of spontaneous spinal hemorrhage in the pediatric age-group. There has to be a high index of suspicion of spontaneous spinal bleed in patients with acute-onset quadriparesis with no prior history of bleeding or trauma, as early diagnosis and surgical decompression is associated with better neurological outcomes.

Cytomegalovirus induced refractory TTP in an immunocompetent individual: a case report

BackgroundThrombotic thrombocytopenic purpura (TTP) is a rare, potentially fatal disease with multisystem involvement. Cytomegalovirus (CMV) infection as a cause of refractory TTP, has been reported only in immunocompromised individuals. We report a case of CMV-induced refractory TTP in an immunocompetent individual.Case presentationA 35-year-old, previously healthy Sri Lankan man, presented with fever for 3 days with gum bleeding and progressive drowsiness. His Glasgow coma scale score was 10/15. He did not have papilloedema or neck stiffness. Laboratory evaluation showed a severe thrombocytopenia with microangiopathic haemolytic anaemia. There was marginal renal impairment and normal coagulation profile. Non-contrast CT scan of brain was normal. A diagnosis of thrombotic thrombocytopenic purpura was made. Despite daily plasma exchanges and high-dose steroids, he failed to achieve the expected therapeutic response, thus demonstrating refractory TTP. On exploring for possible causes of refractoriness to treatment, a clinically significant PCR titre of CMV was detected. Treatment of CMV infection lead to complete recovery of TTP. His disease course was further complicated with spontaneous spinal haemorrhage leading to neurological sequelae.Discussion and conclusionsThis is the first report of CMV induced refractory TTP in an immunocompetent adult. It is also the first report of clinically significant spontaneous spinal haematoma in TTP. These two rare occurrences should be considered when patients with refractory TTP do not improve as expected.

Spontaneous Spinal Haemorrhage as a Complication of Oral Anticoagulant Therapy: A Case Report and Literature Review.

Spinal cord haematoma, or haematomyelia, is a rare condition caused by several unusual disease processes. Traumatic events, such as spinal cord injury and surgery or procedures involving the spinal cord, are the most important causes of spinal cord haematoma. Rarely, it is associated with anticoagulation therapy. Irrespective of cause, spinal cord haematoma is considered a neurosurgical emergency and must be treated promptly in order to prevent neurological sequelae. The authors describe the case of a 69-year-old patient taking warfarin in the therapeutic range for a mechanic mitral valve, who developed chest pain with cervical and dorsal radiation, and experienced sudden paraparesis of the limbs. A CT of the spine confirmed haematomyelia. A high index of suspicion, prompt recognition and immediate intervention are essential to prevent major morbidity and mortality from intraspinal haemorrhage.LEARNING POINTSThis article reports an unusual presentation of spontaneous spinal haematoma, imposing the careful elaboration of differential diagnoses, which is very important in internal medicine.The description of this low-incidence case allows the scientific community to assist in approaching patients with similar symptoms.The lack of studies about the etiology and treatment of spontaneous spinal haematoma underlines the need for further studies and research in the area in order to increase the scientific evidence on the approach of these patients.

A case of microscopic polyangiitis presenting with acute spinal subdural hemorrhage.

This report describes a case of a 62-year-old woman with microscopic polyangiitis (MPA) who developed acute spinal subdural hemorrhage. MPA was confirmed by positive autoantibodies to myeloperoxidase and focal segmental necrotizing and pauci-immune crescentic glomerulonephritis on renal biopsy. She did not recover from paraplegia due to acute spinal subdural hemorrhage, despite decompression operation and aggressive immunosuppression. Although spontaneous spinal hemorrhage in MPA patients is very rare, the prognosis for such patients is poor. Considering the possibility of ongoing vasculitis activity in extra-renal organs, clinicians should be very cautious to attenuate the strength of immunosuppressant drugs, even in patients with chronic or irreversible renal pathology.