전이성 척추 종양의 척추 전 절제술 후 발생한 급성 및 지연성 경막외 혈종 - 증례 보고 -

김영규,김정훈 대한척추외과학회 2019 대한척추외과학회지 Vol.26 No.3

연구 계획: 증례 보고목적: 전 척추 절제술 시행 후 두 차례 발생한 수술 후 경막 외 혈종 증례를 보고하고자 한다. 선행 연구 문헌의 요약: 척추 수술 후 경막 외 혈종은 드물며 혈종 제거술을 시행한 뒤 지연성 경막 외 혈종이 다시 나타난 예는 보고된 적이 없었다. 대상 및 방법: 74세 여환에서 제 9흉추(T9)의 전이성 척추 종양에 의한 병적 골절이 발생하여 전 척추 절제술을 시행하였으며 수술 직후 발생한 경막 외혈종으로 신경학적 증상이 악화되어 혈종 제거술을 시행하여 증상이 호전되었으나 수술 10일 후 신경학적 증상이 다시 악화되어 촬영한 자기 공명 영상검사상 지연성 경막 외 혈종이 또 다시 발견되어 혈종 제거술을 다시 시행하였다. 결과: 지연성 혈종 제거술 재 시행 후 신경학적 증상이 호전되었다. 결론: 일차적인 혈종 제거술 후에도 증상을 일으키는 지연된 혈종이 나타날 수 있으며, 혈종 제거술 후에도 신경학적 증상의 악화가 보인다면 혈종의 재발 가능성을 고려해야 한다. 또한 전 척추 절제술을 시행하기 전에 예방적 색전술을 시행할 것을 추천한다. 약칭 제목: 척추 수술 후 재발한 척수 경막 외 혈종 Study Design: Case report. Objectives: We report a case of recurrent spinal epidural hematoma after total spondylectomy for a metastatic spinal tumor. Summary of Literature Review: Postoperative epidural hematoma is rare, and no case of delayed epidural hematoma after hematoma removal has been reported. Materials and Methods: A 74-year-old woman experienced a ninth thoracic vertebral (T9) pathologic fracture caused by a metastatic spinal tumor and underwent total spondylectomy. Immediate postoperative epidural hematoma occurred and neurological symptoms appeared. After hematoma removal, the symptom improved. Ten days after surgery, the neurological symptoms worsened again. Spine magnetic resonance imaging showed delayed epidural hematoma. Hematoma removal was done again. Results: The patient’s neurological symptoms improved after delayed hematoma removal. Conclusions: Delayed hematoma that cause neurological symptoms may occur after primary hematoma removal. If neurological symptoms recur after hematoma removal, the surgeon should consider the possibility of hematoma recurrence. Before total spondylectomy surgery, preoperative embolization is recommended. Key Words: Delayed epidural hematoma, Metastatic spinal tumor, total spondylectomy

Changes of the Anterior Horn Cells of the Spinal Cord by Induced Spinal Epidural Hematoma in Rabbits

Choi, Joo Young,Shin, Mi Young CATHOLIC MEDICAL CENTER 1993 Bulletin of the Clinical Research Institute Vol.21 No.2

In order to evaluate the influence of induced spinal epidural hematoma to the anterior horn cells of the spinal cord in rabbits were studied. We studied two groups of rabbits: a control group and an induced epidural hematoma group. In the epidural hematoma group (N=6) mean arterial pressure and epidural pressure were measured at 5 minute intervals during perfusion of the arterial blood from the left femoral artery into the sacral canal for 65 minutes. Also, cerebrospinal fluid pressure was continuously monitored. To compare the ischemic changes of the anterior horn cells in the spinal cord, a control group was subdivided into a normal group (N=3), 60 minutes cross-clamping of the abdominal aorta group (N=5) and a 90 minutes cross-clamping of the abdominal aorta group (N=3). At the end of experiment the 6th~7th lumbar vertebral region was obtained and histological study was performed on all rabbits. During the perfusion of arterial blood into the sacral canal cerebrospinal fluid pressure and mean arterial pressure were relatively stable, but measured epidural pressure was abrutly raised from mean control of 11.4 mmHg to 59.4 mmHg in 10 minutes, thereafter, about 66 mmHg of epidural pressure was maintained throughout the experiment. Morphological features of the ventrolateral motor neurons in epidural hematoma group appeared similar to those of the normal control group, but on the other hand in cross-clamping of the abdominal aorta groups, cells were subjected to ischemia or infarction due to duration of the clamping. We observed that blood injected to the sacral canal was diverged from the epidural space through the intervertebral foramen and perimysial lymphatics of the posterior spinal muscles, the collecting lymphatics and common iliac lymph nodes, were filled up with many red blood cells of hematoma.

Spinal epidural hematoma related to an epidural catheter in a cardiac surgery patient -A case report-

Jiyoun Bang,김종욱,이유미,Junghwa Joh,Eun-Hye An,Jae-young Lee,Ji Yeon Kim,최인철 대한마취통증의학회 2011 Korean Journal of Anesthesiology Vol.61 No.6

The addition of thoracic epidural anesthesia to general anesthesia during cardiac surgery may have a beneficial effect on clinical outcome. However, epidural catheter insertion in a patient anticoagulated with heparin may increase the risk of epidural hematoma. We report a case of epidural hematoma in a 55-year-old male patient who had a thoracic epidural placed under general anesthesia preceding uneventful mitral valve replacement and tricuspid valve annular plasty. During the immediate postoperative period and first postoperative day, prothrombin time (PT) and activate partial thromboplastin time (aPTT) were mildly prolonged. On the first postoperative day, he complained of motor weakness of the lower limbs and back pain. An immediate MRI of the spine was performed and it revealed an epidural hematoma at the T5-6 level. Rapid surgical decompression resulted in a recovery of his neurological abnormalities to near normal levels. Management and preventing strategies of epidural hematoma are discussed.

Middle meningeal artery embolization to treat progressive epidural hematoma: a case report

Tae Joon Park,Sang Pyung Lee,Jinwook Baek,Kyoungsoo Ryou,김성환 대한뇌혈관외과학회 2020 Journal of Cerebrovascular and Endovascular Neuros Vol.22 No.1

Progressive epidural hematoma is a form of acute epidural hematoma that gradually expands from a small initial hematoma; in cases that are clinically aggravated due to the presence of a mental illness or neurological condition, patients should be surgically treated for evacuation of the hematoma, but poorer outcomes are expected if the patient has several medical co-morbidities for surgery. We experienced two cases of progressive epidural hematoma which were successfully managed by endovascular treatment: an 85-year-old male with medical co-morbidities and a 51-year-old female with a poor-grade subarachnoid hemorrhage resulting from the rupture of a dissecting aneurysm of the vertebral artery. In both cases, a middle meningeal artery embolization was performed and contrast leakage was observed and controlled using cerebral angiography, halting the progression of their epidural hematomas. Thus, endovascular embolization of a middle meningeal artery may play a useful role in salvage therapy in certain complicated situations that limit treatment of the hematoma by surgical evacuation.

Rapid Spontaneous Resolution of Idiopathic Cervico-thoracic Ventral Epidural Hematoma

김종열,김경현,구성욱,조용은 대한척추신경외과학회 2010 Neurospine Vol.7 No.3

Spontaneous spinal epidural hematoma(SSEH) has been rarely reported in the literature. Prompt surgical intervention is recommended for patients with neurologic deficit. However. in rare cases, spontaneous resolution of the SSEH with recovery of the neurological deficit has also been reported. We report a case of SSEH in a 55-year-old woman with a rapidly progressing neurological deficit. Her neurological deficits gradually improved sponta- neously during preoperative evaluation. Serial magnetic resonance imaging(MRI) demonstrated disappearance of the hematoma. Since her neurological status improved within a few hours, we recommended conservative care. Patients initially presenting with severe neurologic dysfunction are potential candidates for conservative management if they demonstrate rapid and progressive improvement in neurologic function. Thus, immediate surgical decompression may not be necessary if neuroimaging and clinical examinations suggest that spinal epidural hematoma will spontaneously resolve. Spontaneous spinal epidural hematoma(SSEH) has been rarely reported in the literature. Prompt surgical intervention is recommended for patients with neurologic deficit. However. in rare cases, spontaneous resolution of the SSEH with recovery of the neurological deficit has also been reported. We report a case of SSEH in a 55-year-old woman with a rapidly progressing neurological deficit. Her neurological deficits gradually improved sponta- neously during preoperative evaluation. Serial magnetic resonance imaging(MRI) demonstrated disappearance of the hematoma. Since her neurological status improved within a few hours, we recommended conservative care. Patients initially presenting with severe neurologic dysfunction are potential candidates for conservative management if they demonstrate rapid and progressive improvement in neurologic function. Thus, immediate surgical decompression may not be necessary if neuroimaging and clinical examinations suggest that spinal epidural hematoma will spontaneously resolve.

두부외상성 원발병소 수술 후 원발병소 반대측에 발생한 지연성 뇌경막외 혈종에 대한 임상적 경험

이승호,어환,이규호,정봉섭 대한신경외과학회 1995 Journal of Korean neurosurgical society Vol.24 No.11

325 patients underwent emergency evacuation of traumatic intracranial hematomas over a 5-year period. Ten(3%) developed delayed contralateral epidural hematomas. These hematomas were not present on initial computed tomography(CT) scan, but repeat CT scan after craniectomy showed sizable hemorrhage. The authors analyzed 10 cases with delayed post-traumatic contralateral epidural hematoma according to their etiology, hematoma types on computerized tomogaphy, initial Glasgow Coma Scale (GCS) follow up easgow Outcome Scale(GOS) & follow up Galsgow Outcome Scale(GOS). 1) Delayed development of post-traumatic contralateral epidural hematoma after evacuation of initial hematoma occurred in 10 of the 325 head injured patients, an incidence rate of 3%. 2) The important factors affecting patients outcome were the inital GCS & the time interval after surgery. 3) Eight patients were found to have a skull fracture at the site of delayed epiduralhematoma formation(80%). 4) The results of delayed contralateral epidural hematoma was 50% good, 50% bad and had a morality rate of 30%.

혈종으로 오인된 경막외 림프종 - 증례 보고 -

이동영,김동희,정순택,김근태,양정욱 대한척추외과학회 2017 대한척추외과학회지 Vol.24 No.1

Study Design: Case report. Objectives: To present a rare case of a spinal epidural lymphoma mimicking a hematoma. Summary of Literature Review: The incidence of extranodal invasion of lymphoma is very low, and spinal compression as a clinical symptom rarely occurs in extranodal lymphoma. Materials and Methods: A 37-year-old woman who complained of neck pain that had lasted for the past 3 months with no underlying disease visited the hospital and was treated conservatively with medication and physical therapy. Even though the patient was given an epidural injection 1 month prior to visiting our hospital, the pain lingered and the cervical myelopathy became aggravated, so the patient was initially diagnosed with epidural hematoma. This predisposed the patient to treatment strategies such as laminectomy and fusion, but the patient was ultimately diagnosed with non-Hodgkin lymphoma. Results: The patient underwent a laminectomy with excision of the lesion and fusion. The patient was diagnosed with non-Hodgkin lymphoma as a result of this, and the patient’s radicular pain and numbness improved immediately following surgery, except for mild weakness in both hands. Conclusions: Although spinal epidural lymphoma is similar to hematoma, and is a very rare disease, surgeons should take it into consideration in the differential diagnosis of patients with a spinal epidural lesion. Key words: Myelopathy, Epidural, Lymphoma, Non-Hodgkin lymphoma, Hematoma 연구 계획: 증례 보고목적: 혈종과 유사한 경막외 림프종으로 진단된 드문 증례를 보고하고자 한다. 선행문헌의 요약: 림프종이 임파선 외에서 발생하는 빈도는 매우 낮으며, 척수 압박으로 인한 임상 양상이 나타나는 경우도 매우 드물다. 대상 및 방법: 특이 기저질환이 없던 37세 여자 환자에서 3개월 전부터 지속되는 목 통증으로 약물 치료 및 물리 치료의 보존적 치료 시행하였으며, 내원1개월 전 경추 경막외 주사 요법 시행 후에도 지속되는 목 통증 및 진행하는 경추 척수증 증상으로 내원한 환자에서 경막외 혈종으로 의증하여 후궁 절제술 및 유합술 시행 후 비호지킨 림프종으로 진단된 증례이다. 결과: 후궁절제술 및 병변 절제술 후 유합술을 시행하였으며, 최종적으로 비호지킨 림프종으로 진단되었다. 수술 후 방사통과 무딘감은 즉시 호전되었으며, 경도의 양손 위약감은 수술 후 3개월까지도 지속되었다. 결론: 비록 척추 경막외 림프종은 혈종과 유사하며 매우 드문 질환이나, 척추 경막외 종양 수술시 반드시 감별 질환으로 고려되어야 한다. 색인 단어: 척수증, 경막외, 림프종, 비호지킨 림프종, 혈종약칭 제목: 혈종으로 오인된 경막외 림프종

Posterior Epidural Herniation of a Lumbar Disk Fragment at L2-3 That Mimicked an Epidural Hematoma

길진상,박종태 대한척추신경외과학회 2017 Neurospine Vol.14 No.3

Lumbar disk herniation is common. Because of the posterior longitudinal ligament, migration usually occurs into the ventral epidural space. Rarely, fragments migrate into the dorsal epidural space. A 57-year-old man presented with lower back pain and weakness on right hip flexion and right knee flexion. He had lower back pain 1 day previously and received a transforaminal epidural block at a local hospital. The next day, he reported weakness of the right lower extremity. Lumbar spine magnetic resonance imaging revealed a dorsal epidural lesion with compression of the thecal sac at L2-3. Initial differential diagnoses included epidural hematoma after the block, neoplasm, and a sequestrated disk. Posterior lumbar decompression was performed. The lesion was identified intraoperatively as a large herniated disk fragment. Posterior epidural herniation of a lumbar disk fragment is rare and may be difficult to diagnose preoperatively. It may present as a variety of clinical scenarios and, as in this case, may mimic epidural hematoma.

Sudden Hemiplegia by Epidural Hematoma in a Patient Treated with Warfarin and Therapeutic Range International Normalized Ratio

Hyeong-Won Seo,Hyung Wook Park,Ki Hong Lee,Joon-Ho Ahn,Nam Sik Yoon,Jeong Gwan Cho 순천향대학교 순천향의학연구소 2015 Journal of Soonchunhyang Medical Science Vol.21 No.2

Spontaneous spinal epidural hematoma is extremely rare. It can cause fatal complication such as permanent neurologic deficit. Even though the exact cause of epidural hematoma is not known in most cases, anticoagulation treatment is associated in some cases. In this situation, prompt reversal of anticoagulation and immediate decompression surgery is required. Seventy-year-old woman presesnted with sudden hemiplegia. She had history of hypertension, dyslipidemia, and paroxysmal atrial fibrillation and had taken antihypertensive agent, statin, and warfarin. She did not have any history of trauma and her international normalized ratio was within therapeutic range during follow-up and at the time of event. Physical examination revealed decreased right extremities’ motor and sensory function but cognitive function was normal. Detailed neurologic examination and spinal magnetic resonance imaging identified extensive, spontaneous spinal epidural hematoma. After the reversal of anticoagulation with vitamin K injection, the patient underwent emergent hematoma removal surgery and recovered completely. Our case suggests epidural hematoma should be considered in sudden hemiplegia patients with anticoagulation therapy. Immediate reversal of anticoagulation and decompression surgery can avoid neurologic deficit.

Spinal Epidural Hematoma after Pain Control Procedure

Nam, Kyoung-Hyup,Choi, Chang-Hwa,Yang, Moon-Seok,Kang, Dong-Wan The Korean Neurosurgical Society 2010 Journal of Korean neurosurgical society Vol.48 No.3

Spinal epidural hematoma is a rare complication associated with pain control procedures such as facet block, acupuncture, epidural injection, etc. Although it is an uncommon cause of acute myelopathy, and it may require surgical evacuation. We report four patients with epidural hematoma developed after pain control procedures. Two procedures were facet joint blocks and the others were epidural blocks. Pain was the predominant initial symptom in these patients while two patients presented with post-procedural neurological deficits. Surgical evacuation of the hematoma was performed in two patients while in remaining two patients, surgery was initially recommended but not performed since symptoms were progressively improved. Three patients showed near complete recovery except for one patient who recovered with residual deficits. Although, spinal epidural hematoma is a rare condition, it can lead to serious complications like spinal cord compression. Therefore, it is important to be cautious while performing spinal pain control procedure to avoid such complications. Surgical treatment is an effective option to resolve the spinal epidural hematoma.