Article Menu

Export Article

More by Authors Links

Article Data

  • Views 2415
  • Dowloads 213

Case Reports

Open Access Special Issue

Particularities of clinical onset and favorable evolution towards functional neurorehabilitation in a very large post-acenocoumarol overdose hematoma (C7-T10) —a case report

  • Aura Spinu1,2,†
  • Cristina Daia1,2,†
  • Cristina Popescu2,†
  • Ioana Andone1,2,†
  • Theodora Ionescu2,†
  • Ana Cristea2,†
  • Mihai Baila2,†
  • Costica Zamfir3,†
  • Gelu Onose1,2,†

1Physical and Rehabilitation Medicine Department, Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila", 020021 Bucharest, Romania

2The Neuromuscular Rehabilitation Clinic Division, Teaching Emergency Hospital "Bagdasar-Arseni" (TEHBA), 041915 Bucharest, Romania

3The Neurosurgery II Clinic Division, Teaching Emergency Hospital “Bagdasar-Arseni” (TEHBA), 041915 Bucharest, Romania

DOI: 10.22514/sv.2021.112 Vol.17,Issue 5,September 2021 pp.151-157

Submitted: 20 April 2021 Accepted: 18 May 2021

Published: 08 September 2021

(This article belongs to the Special Issue Spinal Cord Injury)

*Corresponding Author(s): Cristina Popescu E-mail: cristina_popescu_recuperare@yahoo.com

† These authors contributed equally.

PDF (554.03 kB) View Full-text

Abstract

Introduction: The incidence of spontaneous spinal epidural hematoma is relatively rare and it may cause a spinal cord injury possibly associated with related severe disabling conditions: sensory-motor impairments, back pain, neurogenic bladder and bowel. The MRI is the golden standard diagnostic examination in patients suspected of spinal epidural hematoma. Still, such a spontaneous condition can be, not-seldom, asymptomatic.

Materials and methods: This paper presents the case of a 79-year-old male patient with permanent atrial fibrillation, treated with acenocoumarol, who was admitted, first in the General Surgery Clinic Division with rectal tenesmus and acute urinary retention and, subsequently developed a sudden onset of motor deficit, as presented in the body text. The patient was diagnosed with epidural hematoma (C7-T10) resulting in AIS/Frankel C paraplegia, with T10 neurological level. The positive and differential diagnoses concluded that the acenocoumarol overdose was the main etiopathogenic factor.

Results: The patient—being promptly transferred to the Spinal Neurosurgical Clinic Division—received conservative treatment, followed by a neuro-muscular rehabilitation program achieved in our Neuro-Rehabilitation Clinic Division, with mainly favorable outcomes: at discharge he was able to walk independently on short distances.

Conclusions: The clinical outcomes and quality of life of patients suffering from spinal epidural hematoma depend on the fast diagnosis and efficient acute neurosurgical/conservative treatment, followed by an appropriate rehabilitation program, including with medium and long term medical follow-up. This clinical case has received the Teaching Emergency Hospital “Bagdasar-Arseni” Bioethics Committee approval No. 27/1935-25.02.2021.


Keywords

Spinal epidural hematoma; Neurorehabilitation; Acenocoumarol overdose; Neurologic deficit; Neurogenic bladder


Cite and Share

Aura Spinu,Cristina Daia,Cristina Popescu,Ioana Andone,Theodora Ionescu,Ana Cristea,Mihai Baila,Costica Zamfir,Gelu Onose. Particularities of clinical onset and favorable evolution towards functional neurorehabilitation in a very large post-acenocoumarol overdose hematoma (C7-T10) —a case report. Signa Vitae. 2021. 17(5);151-157.

URL:

https://www.signavitae.com/articles/10.22514/sv.2021.112

References

[1] Figueroa J, DeVine JG. Spontaneous spinal epidural hematoma: literature review. Journal of Spine Surgery. 2017; 3: 58–63.

[2] Bhat K, Kapoor S, Watali Y, Sharma J. Spontaneous epidural hematoma of spine associated with clopidogrel: a case study and review of the literature. Asian Journal of Neurosurgery. 2015; 10: 54.

[3] Babayev R, Ekşi MS. Spontaneous thoracic epidural hematoma: a case report and literature review. Child’S Nervous System. 2016; 32: 181–187.

[4] Bakker NA, Veeger NJGM, Vergeer RA, Groen RJM. Prognosis after spinal cord and cauda compression in spontaneous spinal epidural hematomas. Neurology. 2015; 84: 1894–1903.

[5] Dziedzic T, Kunert P, Krych P, Marchel A. Management and neurological outcome of spontaneous spinal epidural hematoma. Journal of Clinical Neuroscience. 2015; 22: 726–729.

[6] Knipe H, Saber M. Spinal epidural hematoma. 2019 . Available at: https://radiopaedia.org/articles/spinal-epidural-haematoma (Accessed: 20 March 2021).

[7] Khairat A, Waseem M. Epidural Hematoma. 2021. Available at: https: //pubmed.ncbi.nlm.nih.gov/30085524/ (Accessed: 20 March 2021).

[8] Raeouf A, Goyal S, Van Horne N, Traylor J. Spontaneous Spinal Epidural Hematoma Secondary to Rivaroxaban Use in a Patient with Paroxysmal Atrial Fibrillation. Cureus. 2020; 12: e10417.

[9] Nelson A, Benzon HT, Jabri RS. Diagnosis and Management of Spinal and Peripheral Nerve Hematoma. 2017. Available at: https://www.nysora.com/foundations-of-regional-anesthesia/complications/diagnosis-management-spinal-peripheral-nerve-hematoma/ (Accessed: 20 March 2021).

[10] Chien C. Spinal Epidural Hematoma. 2006. Available at: https: //coreem.net/core/spinal-epidural-hematoma (Accessed: 20 March 2021).

[11] Brawn LA, Bergval UE, Davies-Jones GA. Spontaneous spinal epidural haematoma with spontaneous resolution. Postgraduate Medical Journal. 1986; 62: 885–887.

[12] Duffill J. Can spontaneous spinal epidural haematoma be managed safely without operation? A report of four cases. Journal of Neurology, Neurosurgery & Psychiatry. 2000; 69: 816–819.

[13] Groen RJM. Non-operative treatment of spontaneous spinal epidural hematomas: a review of the literature and a comparison with operative cases. Acta Neurochirurgica. 2004; 146: 103–110.

[14] Pahapill PA, Lownie SP. Conservative Treatment of Acute Spontaneous Spinal Epidural Hematoma. Canadian Journal of Neurological Sciences. 1998; 25: 159–163.

[15] Goyal G, Singh R, Raj K. Anticoagulant induced spontaneous spinal epidural hematoma, conservative management or surgical intervention—a dilemma? Journal of Acute Medicine. 2016; 6: 38–42.

[16] Shin J, Kuh S, Cho Y. Surgical management of spontaneous spinal epidural hematoma. European Spine Journal. 2006; 15: 998–1004.

[17] Onose G, Anghelescu A. Guide to diagnosis, treatment and rehabilitation in spinal cord injuries. Bucharest: “Carol Davila” University Press. 2011.(In Romanian)

[18] American Spinal Injury Association: International Standards for Neurological Classification of Spinal Cord Injury, revised 2000; Atlanta, GA, Reprinted 2008. ASIA 2019 revision. Available at: https://asia-spinalinjury.org/wp-content/uploads/2019/ 04/ASIA-ISCOS-IntlWorksheet_2019.pdf (Accessed: 20 March 2021).

[19] Catz A, Itzkovich M, Tesio L, Biering-Sorensen F, Weeks C, Laramee MT, et al. A multicenter international study on the Spinal Cord Independence Measure, version III: Rasch psychometric validation. Spinal Cord. 2007; 45: 275–291.

[20] Dittuno P, Dittuno Jr J. Walking index for spinal cord injury (WISCI II): scale revision. Spinal Cord. 2001; 39: 654–656.

[21] Holden MK, Gill KM, Magliozzi MR et al. Clinical gait assessment in the neurologically impaired: reliability and meaningfulness. Physical Therapy. 1984; 64: 38–40

[22] Ashworth B. Preliminary trial of carisoprodol in multiple sclerosis. Practitioner. 1964; 192: 540–542.

[23] Burckhardt CS, Anderson KL. The Quality of Life Scale (QOLS): Reliability, Validity, and Utilization. Health Qual Life Outcomes. 2003; 1: 60.

[24] Hoeman SP. Rehabilitiation Nursing: Prevention, Intervention and Outcomes. Elsevier Health Sciences. 2008.

[25] Kavanagh A, Baverstock R, Campeau L, Carlson K, Cox A, Hickling D, et al. Canadian Urological Association guideline: Diagnosis, management, and surveillance of neurogenic lower urinary tract dysfunction. Canadian Urological Association Journal. 2019; 13:157–176.

[26] Steffel J, Collins R, Antz M, Cornu P, Desteghe L, Haeusler K, et al. 2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation. Europace. 2021; euab065.

[27] John K, Knight J, Nigam Y. Effects of bedrest 5: The muscles, joints and mobility. Nursing Times. 2019; 115: 54–57.


Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time

Conferences

Top