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 |
|
|
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.
|
| (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 |
|
|
| (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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