Successful Recovery from Spontaneous Spinal Epidural Hematoma in a Patient Undergoing Hemodialysis.
Successful Recovery from Spontaneous Spinal Epidural Hematoma in a Patient Undergoing Hemodialysis.
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DOI：
10.12659/ajcr.905953
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发表时间：
2017-12-20
期刊：
影响因子：
--
通讯作者：
Koyama K
中科院分区：
文献类型：
--
作者：
Hibi A;Kasugai T;Kamiya K;Kamiya K;Kominato S;Ito C;Miura T;Koyama K
患者：男性，70 岁 最终诊断：自发性脊髓硬膜外血肿 症状：腹痛 • 胸痛 • 完全截瘫 药物治疗： — 临床程序：保守治疗 专业：肾脏科 异常临床过程 自发性脊髓硬膜外血肿 (SSEH) 在没有外伤或医源性原因的情况下发生在脊髓硬膜外腔，被认为是神经急症，因为脊髓受压可能导致神经功能缺损。由于 SSEH 的症状多种多样，可能与中风相似，因此及时诊断可能很困难。接受血液透析（HD）的患者存在因透析期间抗凝而出血和尿毒症的风险。然而，HD患者在接受HD治疗时发生SSEH的报道却很少。一名70岁的日本男子因急性胸腹痛、完全截瘫，在过去三年一直接受HD维护，被送往日本爱知县刈谷丰田综合医院。患者否认最近有任何外伤或医疗程序。磁共振成像显示胸椎和腰椎硬膜外腔存在广泛的血肿，从 T8 延伸到 L5。患者入院后三小时内症状改善，三天后未进行 HD 治疗，SSEH 缩小，患者成功康复，没有残留神经功能缺损，无需手术。由于透析期间的抗凝和尿毒症，HD 患者的 SSEH 管理可能很困难。及时诊断和密切的神经系统监测对于适当的治疗非常重要。对于症状在短时间内改善的患者，可以考虑保守治疗。
Patient: Male, 70 Final Diagnosis: Spontaneous spinal epidural hematoma Symptoms: Abdominal pain • chest pain • complete paraplegia Medication: — Clinical Procedure: Conservative management Specialty: Nephrology Unusual clinical course Spontaneous spinal epidural hematoma (SSEH) occurs in the spinal epidural space in the absence of traumatic or iatrogenic causes, and is considered to be a neurological emergency, as spinal cord compression may lead to neurological deficit. Prompt diagnosis of SSEH can be difficult due to the variety of presenting symptoms, which may resemble those of stroke. Patients who undergo hemodialysis (HD) are at risk of bleeding due to anticoagulation during dialysis and uremia. However, SSEH in HD patients undergoing HD has rarely been reported. A 70-year-old Japanese man, who has been undergoing maintenance HD for the previous three years, was admitted to Kariya Toyota General Hospital, Aichi, Japan, with acute chest and abdominal pain, and with complete paraplegia. The patient denied any recent trauma or medical procedures. Magnetic resonance imaging showed an extensive hematoma in the thoracic and lumbar epidural space, extending from T8 to L5. The patient’s symptoms improved within three hours following hospital admission, and after three days without HD treatment, the SSEH decreased in size, and the patient successfully recovered without residual neurological deficits and without requiring surgery. The management of SSEH in patients undergoing HD can be difficult, due to anticoagulation during dialysis and uremia. Prompt diagnosis and close neurological monitoring are important for appropriate management. In patients whose symptoms improve within a short period, conservative management may be considered.
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DOI：
10.3978/j.issn.2223-4292.2015.01.07
发表时间：
2015-12-01
影响因子：
2.8
作者：
Mohammed, Noor;Shahid, Muhammad;Hoey, Edward T. D.
通讯作者：
Hoey, Edward T. D.
影响因子：
4.8
作者：
Groen, RJM;vanAlphen, HAM
通讯作者：
vanAlphen, HAM
影响因子：
2.8
作者：
Wang, Peng;Xin, Xiao-tang;Liu, Bo
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影响因子：
4.8
作者：
Akimoto T;Yamada T;Shinoda S;Asano Y;Nagata D
通讯作者：
Nagata D
影响因子：
19.7
作者：
Holtas, S;Heiling, M;Lonntoft, M
通讯作者：
Lonntoft, M