Atıf BAYRAMOĞLU, Mürteza ÇAKIR, Gökşin ŞENGÜL, Mustafa Kemal ÇOBAN

Hipertansiyona Bağlı Olarak Gelişen Akut Spinal Epidural Hematom Acute Spinal

Giriş: Akut spinal epidural hematomlar nöroşirurjinin acil tanı ve tedavi gerektiren patolojilerinden biri olup, hipertansiyon nadir görülen bir nedenidir. Ağır nörodefisit ve kalıcı nörolojik sekellere sebep olmamak için erken tanı ve en etkin cerrahi tedavi yöntemi olan spinal kordun en kısa sürede dekompresyonu gerekmektedir. Olgu: 63 yaşında erkek hasta, 12 saat önce bacaklarında kuvvetsizlik, idrar kaçırma şikayeti ile acil servise müracaat etti. Hastanın nörolojik muayenesinde bilateral alt ekstremitelerde 3/5 kuvvet kaybı, Th12 altında seviyesi altında hipoestezi, derin tendon refleksleri alınamadığı, sfinkter kontrolü ve anal refleksin olmadığı görüldü. Geliş sistemik kan basıncı 190/100 mmHg idi. Travma öyküsü olmayan hastanın torakolomber MRGsinde Th12-L1 seviyesinde spinal kordu posteriordan komprese eden akut spinal epidural hematom belirlendi. Hastaya metilprednizolon başlanarak ameliyata alındı. İlgili seviyeye laminektomi yapılarak epidural hematom boşaltıldı. Postoperatif erken dönemde nörodefisitlerinde düzelme olmayan hasta taburcu sonrası rehabilitasyon programına alındı. Hastanın nörodefisitleri 6 ay sonra tamamen düzeldi. Sonuç: Hipertansiyon öyküsü olan hastalarda gelişen akut paraparezilerde spinal epidural hematom ayırıcı tanıda düşünülmelidir. Bu hastalarda erken cerrahi girişime ilave olarak steroid tedavisi ve rehabilitasyon nörodefisitlerde tam düzelme sağlayabilir. Anahtar Kelimeler: Spinal epidural hematom, akut paraparezi, hipertansiyon ABSTRACT

Epidural Hematoma Developed In Conjunction With Hypertension

Introduction: Acute spinal epidural hematoma is one of the pathologies of neurosurgery that require immediate diagnosis and treatment, is a rarely caused by hypertension. Early diagnosis and decompression of spinal cord is needed as soon as possible, not to cause severe neurological deficit and permanent neurological sequelae which the most effective surgical treatment method. Case: Male patient who is 63 year old, applied to the emergency department 12 hours before, with complaints of urinary incontinence and weakness on his legs. After patient's neurological examination it was discovered that there was 3/5 strength loss at bilateral lower extremities, hypoesthesia below the level of Th12, deep-tendon reflexes could not be taken, sphincter control and anal reflex was absent. Systemic blood pressure at inlet side was 190/100 mmHg. It was determined that patient had acute spinal epidural hematoma compressing spinal cord from posterior at the level of Th12-L1, on MRI thoracolumbar of the patient who had no history of trauma. The patient was operated by starting methylprednisolone. Epidural hematoma was evacuated by applying laminectomy to related level. The patient was included in the rehabilitation program who did not have any improvement in neurological deficits at the early postoperative period after discharge. The patient's neurological deficit completely improved after 6 months. Conclusion: For the patients who had a history of hypertension, spinal epidural hematoma with acute paraparesia should be considered in the differential diagnosis. For these patients steroid therapy and rehabilitation in addition to early surgical intervention could cause full recovery of neurological deficit.

PDF

___

1. Shin JJ, Kuh SU, Cho YE. Surgical management of spontaneous spinal epidural hematoma. Eur Spine J. 2006;15:998-1004.
2. Boukobza M, Guichard JP, Boissonet M, et al. Spinal epidural haematoma: report of 11 cases and review of the literature. Neuroradiology. 1994;36:456-9.
3. Kelly MEB, Beavis RC, Hattingh S. Spontaneous spinal epidural hematoma during pregnancy. Canadian Journal of Neurologıcal Sciences. 2005;32:361-5.
4. Ravi D, Dwarakanath S, Satish R. Spontaneous spinal extradural hematoms. Canadian Journal of Clinical Neuroscience. 2006;13:269-72.
5. Caruso G, Galarza M, Borghesi I, Pozzati E, Vitale M. Acute presentation of spinal epidural cavernous angiomas: case report. Neurosurgery. 2007;60:E575-6.
6. Bisson EF, Dumont T, Tranmer B. Spontaneous spinal epidural hematoma in a child with hemophilia B. Canadian Journal of Neurological Sciences. 2007;34:488-90.
7. Kaneda T, Urimoto G, Suzuki T. Spinal epidural hematoma following epidural catheter removal during antiplatelet therapy with cilostazol. J Anesth. 2008;22:290-3.
8. Finsterer J, Seywald S, Stöllberger C, et al. Recovery from acute paraplegia due to spontaneous spinal, epidural hematoma under minimal- dose acetyl-salicylic acid. Neurol Sci. 2008;29:271-3.
9. Thiele RH, Hage ZA, Surdell DL, Ondra SL, Batjer HH, Bendok BR. Spontaneous Spinal Epidural Hematoma of Unknown Etiology: Case Report and Literature Review. Neurocrit Care. 2008;9:242-6.
10. Reddy JJM, Chandra NE, Kalva SP, Murthy S. MR imaging in spontaneous spinal epidural haematoma. Rivista Di Neuroradiologia. 1999;12:525-8.
11. Matsumura A, Namikawa T, Hashimato R, et al. Clinical management for spontaneous spinal epidural hematoma: diagnosis and treatment. Spine J. 2008;8:534-7.
12.Tekkök İH. Spontan intraspinal hematomlar. İçinde Aksoy K (ed). Temel Nöroşirurji. Ankara: Buluş Tasarım ve Matbacılık; 2005:1242-8.