A case of Hemophilia A presenting with paraparesis following lumbar puncture

Abstract

Besides large intra-joint bleedings that are frequently ob­served in Hemophilia A, bleeding may also rarely occur in spinal joints. Additional to traumatic or spontaneous hematomas, cord suppression may be occured due to various reasons such as epidural tumor and infections, myelosclerosis and bone tissue suppression that occurs to the enlargement in the bone marrow because of hemo­lytic anemia and thalassemia. In the present study a 6 months old male who developed paraparesis as a result of spinal compression of a hematoma that occurred after lumbar puncture and then diagnosed with Hemophilia A presented on account of the present case, our aim is to emphasize that perispinal hematoma may lead to para­paresis and that paraparesis may develop due to neuro­logical retention that is rarely seen in children with Hemo­philia A.

Keywords

• Hemophilia, Paraparesis, Children, Spinal Puncture

Lomber ponksiyon sonrası paraparezi ile belirti veren Hemofili A olgusu

Abstract

Hemofili A da büyük eklem içi kanamalar sık görülmesinin yanısıra, nadiren spinal eklemlerde de oluşabilir. Travma­tik ya da spontan hematomların yanısıra kordun baskı­lanması, epidural tümor ve infeksiyonlar, myeloskleroz, hemolitik anemi ve talasemi gibi kemik iliğinde büyüme yaparak kemik dokuyu bastıran pek çok nedenlerle olu­şabilir. Bu çalışmada lomber ponksiyon sonrası gelişen hematomun yaptığı spinal kompresyon sonucu parapa­rezi gelişen 6 aylık erkek olgunun yapılan incelemesi ile ilk Hemofili A tanısı konulması üzerine sunuldu. Amacı­mız bu vaka ile perispinal hematomun parapareziye yol açabileceğini ve hemofili A olgularında görülen nörolojik gerilemenin buna bağlı olabileceğini vurgulamaktır.

Keywords

• Hemofili, paraparezi, çocuk, lomber ponksiyon

References

1. Eftekhar B, Ghodsi M, Ketabchi E, Bakhtiari A, Mostajabi P. Spinal subdural hematoma revealing hemophilia A in a child: A case report. BMC Blood Disord 2003; 3(1): 2.
2. Pai SB, Krishna KN, Chandrashekar S. Post lumbar puncture spinal subarachnoid hematoma causing paraplegia: a short report. Neurol India 2002;50(3): 367-9.
3. Eyster ME, Gill FM, Blatt PM, Hilgartner MW, Mallard JO, Kinney TR. Central nervous system bleeding in hemophili- acs. Blood 1978;51(6): 1179-88.
4. Akçay A, Ünüvar Ö. Preparation of patients with hemophilia for minor and major surgery. Türkiye Klinikleri J Int Med Sci 2006; 2(2):15-9.
5. de Tezanos Pinto M, Fernandez J, Perez Bianco PR. Update of 156 episodes of central nervous system bleeding in he- mophiliacs. Haemostasis 1992; 22(5): 259-67.
6. Faillace WJ, Warrier I, Canady AI. Paraplegia after lumbar puncture. In an infant with previously undiagnosed hemo- philia A. Treatment and peri-operative considerations. Clin Pediatr (Phila) 1989; 28(3): 136-8.
7. Domenicucci M, Ramieri A, Ciappeta P, Delfine R. Nontrau- matic acute spinal subdural hematoma: report of five cases and review of the literature. J Neurosurg 1999; 91(1): 65- 73.
8. Harvie A, Lowe GD, Forbes CD, Prentice CR, Turner J. Intraspinal bleeding in haemophilia: successful treatment with factor VIII concentrate. J Neurol Neurosurg Psychia- try 1977; 40(12): 1220-3.

9. Freger P, Meneses M, Creissard P, Vanier JP, Tadie M, Godlewski J. Intraspinal epidural hematoma in the hemo- philiac. Neurochirurgie 1986; 32(6): 486-9.