Pullarkat V A, Kalapura T, Pincus M, Baskharoun R
Department of Medicine, New York Methodist Hospital, Brooklyn, USA.
Arch Intern Med. 2000 Jan 24;160(2):237-40. doi: 10.1001/archinte.160.2.237.
Intraspinal hemorrhage is a rare but dangerous complication of anticoagulant therapy. It must be suspected in any patient taking anticoagulant agents who complains of local or referred spinal pain associated with limb weakness, sensory deficits, or urinary retention. We describe a patient with hematomyelia, review the literature on hematomyelia and other intraspinal hemorrhage syndromes, and summarize intraspinal hemorrhage associated with oral anticoagulant therapy. The patient (a 62-year-old man) resembled previously described patients with hematomyelia in age and sex. However, he was unusual in having cervical rather than thoracic localization. As with intracranial bleeding, the incidence of intraspinal hemorrhage associated with anticoagulant therapy might be minimized by close monitoring and tight control of the intensity of anticoagulation. However, it is noteworthy that many of the reported cases were anticoagulated in the therapeutic range. If intraspinal hemorrhage is suspected, anticoagulation must be reversed immediately. Emergency laminectomy and decompression of the spinal cord appear mandatory if permanent neurologic sequelae are to be minimized. A high index of suspicion, prompt recognition, and immediate intervention are essential to prevent major morbidity and mortality from intraspinal hemorrhage.
脊髓内出血是抗凝治疗罕见但危险的并发症。对于任何服用抗凝剂且主诉伴有肢体无力、感觉障碍或尿潴留的局部或牵涉性脊柱疼痛的患者，均须怀疑有脊髓内出血。我们描述了1例脊髓出血性软化症患者，回顾了有关脊髓出血性软化症和其他脊髓内出血综合征的文献，并总结了与口服抗凝治疗相关的脊髓内出血情况。该患者（一名62岁男性）在年龄和性别方面与先前描述的脊髓出血性软化症患者相似。然而，其不同寻常之处在于出血部位在颈部而非胸部。与颅内出血一样，通过密切监测和严格控制抗凝强度，可将与抗凝治疗相关的脊髓内出血发生率降至最低。然而，值得注意的是，许多报告病例的抗凝治疗均在治疗范围内。如果怀疑有脊髓内出血，必须立即停用抗凝剂。若要将永久性神经后遗症降至最低，急诊椎板切除术和脊髓减压似乎是必要的。高度的怀疑指数、及时识别和立即干预对于预防脊髓内出血导致的严重发病和死亡至关重要。
