[Iatrogenic cervical epidural hematoma: case report and review of the literature]. / Heamtoma epidural ccervical yatrogenico. Presentacion de un caso clinico y revision de la literatura.

BACKGROUND: Around 600 spinal epidural hematoma cases have been previously reported. Incidence of paraplegia after epidural anesthesia varies between 0,0005 and 0,02%. Several possible etiologies have been described in the literature, including surgery, trauma, anticoagulant therapy, arteriovenous malformations, pregnancy and lumbar puncture. Spinal and epidural anesthesic procedures represent the tenth most common cause. But in combination with anticoagulant therapy, the forementioned procedures increase its incidence until reaching the fifth most common etiological group. We report the case of an 80 year-old-man with a cervical epidural hematoma who had a good outcome with conservative management. CASE REPORT: 80 year-old-man that developed intense cervicalgia with lower limbs weakness showing complete paraplegia and arreflexia 2 hours after analgesic treatment with epidural cervical infiltration for cervicoartrosis. Cervical MRI showed epidural cervical hematoma between C4 and T1 levels. The patient is transferred to our facilities in order to perform surgery. But after showing fast recovery, medical conservative management was elected. After one month, the patient's condition has improved showing no neurological deficits and complete resorption is seen in MRI. CONCLUSIONS: Nowadays, trend is to perform surgery in patients with spinal hematoma and significant neurological deterioration during the first hours. However, good neurological outcomes can be achieved with conservative management, in well selected patients with non progressive, incomplete and partial deficits. Presently, we can not predict which is the best treatment for each case.

Hematoma epidural cervical yatrogénico. Presentación de un caso clínico y revisión de la literatura / Iatrogenic cervical epidural hematoma: case report and review of the literature

Introducción. En la literatura se recogen alrede­dor de 600 casos de hematomas epidurales espinales. En varios estudios, se afirma que la incidencia de para paresia secundaria a anestesia epidural oscila entre 0,0005-0,02%. Se han descrito numerosas etiologías, incluyendo cirugía, traumatismos, anticoagulación, malformaciones arteriovenosas, embarazo, procesos hematológicos y punción lumbar. Los procedimien­tos anestésicos raquídeos y epidurales representan la décima causa más frecuente. Pero en combinación con el tratamiento anticoagulante, dichos procedimientos aumentan su incidencia hasta alcanzar la quinta causa. Publicamos un caso clínico de hematoma epidural cer­vical yatrogénico en el adulto y el buen resultado obte­nido con tratamiento conservador. Caso clínico. Paciente varón de 80 años, que a las 2 horas de tratamiento analgésico de cervicoartrosis mediante infiltración epidural cervical desarrolla intensa cervicalgia y pérdida de fuerza en extremi­dades inferiores, mostrando paraplejia completa con arreflexia. En RM cervical se evidencia hematoma epidural entre los niveles C4 y T1. Es trasladado a nues­tro centro para cirugía pero ante la rápida recuperación se decide tratamiento médico conservador. Al mes de seguimiento, la situación clínica es similar a la previa, sin secuelas con completa reabsorción del hematoma en (..) (AU)

Background. Around 600 spinal epidural hema­toma cases have been previously reported. Incidence of paraplegia after epidural anesthesia varies between 0,0005 and 0,02%. Several possible etiologies have been described in the literature, including surgery, trauma, anticoagulant therapy, arteriovenous malfor­mations, pregnancy and lumbar puncture. Spinal and epidural anesthesic procedures represent the tenth most common cause. But in combination with anticoagulant therapy, the forementioned procedures increase its inci­dence until reaching the fifth most common etiological group. We report the case of an 80 year-old-man with a cervical epidural hematoma who had a good outcome with conservative management. Case report. 80 year-old-man that developed intense cervicalgia with lower limbs weakness showing com­plete paraplegia and arreflexia 2 hours after anal­gesic treatment with epidural cervical infiltration for (..) (AU)