Finsterer Josef, Seywald Stefanie, Stöllberger Claudia, Krugluger Walter, Tscherney Robert, Ulram Andreas, Kleinpeter Günther
Department of Neurology, Krankenanstalt Rudolfstiftung, Vienna, Austria.
Neurol Sci. 2008 Sep;29(4):271-3. doi: 10.1007/s10072-008-0980-8. Epub 2008 Sep 20.
Spontaneous spinal epidural hematoma (SEH) has not been reported under anti-thrombotic therapy with acetyl-salicylic acid (ASA) in a dosage of 50 mg/d.
Spinal MRI, emergency laminectomy.
A 77-yo, HIV-negative female under longterm treatment over three years with ASA 50 mg/d for varicositas, prescribed by her general practitioner, experienced sudden onset back pain with radiation towards both knees after getting up in the morning. One-and-a-half hours later she also developed ascending hypesthesia and weakness originating from both distal lower limbs. Three hours after onset, hypesthesia had reached the T10-level bilaterally and she had become paraplegic. There was reduced intestinal motility, stool incontinence, and urinary hesitancy. MRI of the thoraco-lumbar spine demonstrated a SEH T9-L1 indenting the dural sack and compressing the myelon. Immediately after emergency laminectomy T10-12 with micro-surgical evacuation of the clot, 12 h after onset, she could move both legs again and was able to walk with support 7 days after surgery.
This case shows that SEH occurs under a minimal dose of ASA and that such patients rapidly recover upon immediate surgical decompression and evacuation of the hematoma.
尚未有关于服用50mg/d乙酰水杨酸（ASA）进行抗血栓治疗时发生自发性脊髓硬膜外血肿（SEH）的报道。
脊髓MRI检查、急诊椎板切除术。
一名77岁、HIV阴性女性，由全科医生开具处方，长期服用50mg/d ASA治疗静脉曲张三年，晨起后突发背痛并向双膝关节放射。1个半小时后，她还出现了自双下肢远端开始的上行性感觉减退和无力。发病3小时后，感觉减退双侧已达T10水平，她已出现截瘫。肠蠕动减弱、大便失禁和排尿踌躇。胸腰椎MRI显示T9-L1水平有一SEH压迫硬脊膜囊和脊髓。在发病12小时后急诊行T10-12椎板切除术并显微手术清除血肿，术后她双腿即可再次活动，术后7天可在搀扶下行走。
该病例表明，在最小剂量ASA治疗时可发生SEH，此类患者在立即进行手术减压和清除血肿后可迅速康复。
