Acute Spinal Epidural Hematoma Developed In Conjunction With Hypertension

Yıl 2012, Cilt: 14 Sayı: 2, 60 - 62, 01.07.2012

Mustafa Kemal Çoban Gökşin Şengül Atıf Bayramoğlu Mürteza Çakır

Öz

Introduction: Acute spinal epidural hematoma is one of the pathologies of neurosurgery thatrequire immediate diagnosis and treatment, is a rarely caused by hypertension. Early diagnosisand decompression of spinal cord is needed as soon as possible, not to cause severe neurologicaldeficit 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 neurologicalexamination 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 controland anal reflex was absent. Systemic blood pressure at inlet side was 190/100 mmHg. It wasdetermined that patient had acute spinal epidural hematoma compressing spinal cord fromposterior at the level of Th12-L1, on MRI thoracolumbar of the patient who had no history oftrauma. The patient was operated by starting methylprednisolone. Epidural hematoma wasevacuated by applying laminectomy to related level. The patient was included in therehabilitation program who did not have any improvement in neurological deficits at the earlypostoperative period after discharge. The patient's neurological deficit completely improvedafter 6 months.Conclusion: For the patients who had a history of hypertension, spinal epidural hematoma withacute paraparesia should be considered in the differential diagnosis. For these patients steroidtherapy and rehabilitation in addition to early surgical intervention could cause full recovery ofneurological deficit

Anahtar Kelimeler

Spinal epidural hematoma, acute paraparesis, hypertension

Hipertansiyona Bağlı Olarak Gelişen Akut Spinal Epidural Hematom

Öz

Giriş: Akut spinal epidural hematomlar nöroşirurjinin acil tanı ve tedavi gerektirenpatolojilerinden biri olup, hipertansiyon nadir görülen bir nedenidir. Ağır nörodefisit ve kalıcınörolojik sekellere sebep olmamak için erken tanı ve en etkin cerrahi tedavi yöntemi olan spinalkordun en kısa sürede dekompresyonu gerekmektedir.Olgu: 63 yaşında erkek hasta, 12 saat önce bacaklarında kuvvetsizlik, idrar kaçırma şikayetiile acil servise müracaat etti. Hastanın nörolojik muayenesinde bilateral alt ekstremitelerde 3/5kuvvet kaybı, Th12 altında seviyesi altında hipoestezi, derin tendon refleksleri alınamadığı,sfinkter kontrolü ve anal refleksin olmadığı görüldü. Geliş sistemik kan basıncı 190/100 mmHgidi. Travma öyküsü olmayan hastanın torakolomber MRG’sinde Th12-L1 seviyesinde spinalkordu posteriordan komprese eden akut spinal epidural hematom belirlendi. Hastayametilprednizolon başlanarak ameliyata alındı. İlgili seviyeye laminektomi yapılarak epiduralhematom boşaltıldı. Postoperatif erken dönemde nörodefisitlerinde düzelme olmayan hastataburcu sonrası rehabilitasyon programına alındı. Hastanın nörodefisitleri 6 ay sonra tamamendüzeldi.Sonuç: Hipertansiyon öyküsü olan hastalarda gelişen akut paraparezilerde spinal epiduralhematom ayırıcı tanıda düşünülmelidir. Bu hastalarda erken cerrahi girişime ilave olarak steroidtedavisi ve rehabilitasyon nörodefisitlerde tam düzelme sağlayabilir

Anahtar Kelimeler

Spinal epidural hematom, akut paraparezi, hipertansiyon

Kaynakça

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