• PDF / 142,097 Bytes
• 1 Pages / 595.245 x 841.846 pts (A4) Page_size
• 55 Downloads / 180 Views

DOWNLOAD

REPORT

---

1

S

Concomitant intracranial and spinal subdural haematomas in an elderly patient: case report A 67-year-old woman developed concomitant intracranial and spinal subdural haematomas (SDHs) during oral antiplatelet treatment with aspirin and clopidogrel for atrial fibrillation. The woman had received combined low-dose aspirin [dosage not stated] and clopidogrel [Plavix] 75 mg/d for 3 years. She presented with back pain, bilateral radiating leg pain and a severe bitemporal headache. On physical examination, she was fully oriented and alert. A neurologic examination showed a slight motor weakness (grade 4+) and numbness in her lower extremities. Immediate brain and spine MRIs revealed a subacute SDH in the left frontotemporo-parietal region that was 8mm at its thickest point and a well-demarcated intradural lesion, isodense with the dural sac, that measured 8mm at its maximum diameter and compressed the cauda equina at level L4-S1; from the MRI findings, she was diagnosed with concomitant cranial and spinal SDHs. The woman’s headache fluctuated in severity and was resistant to medical treatment; 7 days after admission, she underwent evacuation of the haematoma under local anaesthesia and her headache immediately improved. Her spinal SDH was treated conservatively. In order to exclude other diagnoses, a lumbar puncture was conducted at the level of L5-S1; a CSF analysis showed 190 000 RBCs/mm3 and 267 WBCs/mm3. A brain CT scan and a lumbar spine MRI conducted 14 days after admission showed complete resolution of her spinal SDH. On follow-up at 12 months, she was free of neurological problems and was in good health. Author comment: "Oral antiplatelet therapy and brain atrophy with aging may have facilitated the rebleeding and migration of the [cranial] hematoma." However, "there is not enough to rule out the possibility of chronic subdural haematoma due to an accidental minor injury to the head". Wang US, et al. Spontaneous concomitant intracranial and spinal subdural hematomas in association with anticoagulation therapy. Journal of Korean Neurosurgical Society 51: 237-239, No. 4, Jun 2012. Available from: URL: http:// 803076009 dx.doi.org/10.3340/jkns.2012.51.4.237 - South Korea

0114-9954/10/1416-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

Reactions 25 Aug 2012 No. 1416