Case Report
Spontaneous Recovery of Paraplegia Caused by Spinal Epidural Hematoma after Removal of Epidural Catheter
Table 1
Characteristics of patients with spontaneous recovery of paraplegia due to SEH associated with epidural anesthesia.
(a) |
| Reference | Sex | Age (year) | Diagnosis, Operation | Concurrent disease | Preoperative PLT counts and coagulation studies | Epidural puncture |
| Our case | F | 60 | Epithelioid granuloma, thracoscopic partial lung resection | HT, DM | PLT /L PT-INR 0.92 APTT 26.7 s | Straightforward | [2] | F | 78 | Polyarticular rheumatoid arthritis, total knee replacement | HT, DM | WNL | Straightforward | [3] | F | 90 | Gastric adenocarcinoma, subtotal gastrectomy | Peptic ulcer disease | WNL | Straightforward | [4] | F | 73 | Kidney tumor, left nephrectomy | None | WNL | Straightforward | [5] | F | 72 | Bile duct stenosis and cholelithiasis, choledochoduodenostomy and cholecystectomy | None | WNL | Straightforward | [6] | M | 71 | Gastric cancer and rectal cancer, miles surgery and gastrectomy | HT, ossification of the posterior longitudinal ligament (T10-L1) | WNL | Straightforward | [7] | F | 69 | Lung cancer, partial resection of the lung | Cirrhosis of the liver | PLT /L PT 54% | Prior attempt at T7/8 abandoned due to backflow of blood in the Touhy needle |
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SEH: spinal epidural hematoma, PLT: Platelet count, HT: hypertension, DM: diabetes mellitus, PT: prothrombin time, INR: international normalized ratio, APTT: activated partial thromboplastin time, POD: postoperative day, WNL: within normal limits, EDC: epidural catheter, MRI: magnetic resonance image, NS: not stated.
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(b) |
| Reference | Insertion site of epidural catheter | Anticoagulant therapy | Onset of symptoms | Epidural catheter at the time of onset of paraplegia | Symptoms |
| Our case | T5/6 | None | POD 1 | 10 min after removal | Vomiting Paraplegia | [2] | L2/3 | Enoxaparin, postoperatively | POD 2 | Indwelling | Back pain Paraplegia | [3] | T8/9 | Unfractionated heparin, postoperatively | POD 2 | Indwelling | Paraplegia | [4] | T12/L1 | Enoxaparin 24 h before surgery until 2 h before removal of EDC on POD 3 | POD 3 | Immediately after removal | Back pain Paraplegia Absent anal sphincter reflex | [5] | T7/8 | None | POD 2 | Indwelling | Paraplegia | [6] | T12/L1 | None | POD 5 | 30 min after removal | Paraplegia | [7] | T9/10 | None | POD 5 | After surgery, blood was noted at the insertion point of the catheter, which was then the removed | Paraplegia |
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(c) |
| Reference | Extent of SEH | Coagulation studies at the time of SEH occurrence | Time to improvement after occurrence of paraplegia | Treatment | Reason that surgery was not done | Follow-up neurologic deficits |
| Our case | T1-9 | PLT /L PT-INR 1.03 APTT 27.4 s | 1 h | None | Motor function in legs began to return during MRI | 3 d later: none | [2] | T10-L1 | PLT /L PT-INR 1.04 | On the same day | NS | Motor function in legs began to return before surgery | 3 mon later: none | [3] | T3-11 | PLT /L PT-INR 1.1 APTT 32.6 s | By the next morning | NS | Age, advanced malignancy, >12 h after paraplegia occurred | 56 d later: none | [4] | T11-L1 | NS | On the same day | Dexamethasone | At the time of the neurosurgical examination, motor function had returned to legs | 7 d later: none | [5] | T6-9 | WNL | On the next day | Dexamethasone | Motor function in legs returned after MRI | 40 d later: none | [6] | T11-L1 | NS | 1 h | None | 1 h after paraplegia occurred, paralysis had resolved completely | 1 h later: none | [7] | T4-8 | PLT /L PT 42% | Between the next day and POD 4 | Glycerol Steroid | On POD 2, neurologic findings had stabilized and seemed unlikely to deteriorate | 1 mon later: mild hypoesthesia of left leg |
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