Hibi Arata, Kasugai Takahisa, Kamiya Keisuke, Kamiya Keisuke, Kominato Satoru, Ito Chiharu, Miura Toshiyuki, Koyama Katsushi
Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, Kariya, Aichi, Japan.
Division of Nephrology and Rheumatology, Department of Internal Medicine, Aichi Medical University Hospital, Nagakute, Aichi, Japan.
Am J Case Rep. 2017 Dec 20;18:1357-1364. doi: 10.12659/ajcr.905953.
BACKGROUND Spontaneous spinal epidural hematoma (SSEH) occurs in the spinal epidural space in the absence of traumatic or iatrogenic causes, and is considered to be a neurological emergency, as spinal cord compression may lead to neurological deficit. Prompt diagnosis of SSEH can be difficult due to the variety of presenting symptoms, which may resemble those of stroke. Patients who undergo hemodialysis (HD) are at risk of bleeding due to anticoagulation during dialysis and uremia. However, SSEH in HD patients undergoing HD has rarely been reported. CASE REPORT A 70-year-old Japanese man, who has been undergoing maintenance HD for the previous three years, was admitted to Kariya Toyota General Hospital, Aichi, Japan, with acute chest and abdominal pain, and with complete paraplegia. The patient denied any recent trauma or medical procedures. Magnetic resonance imaging showed an extensive hematoma in the thoracic and lumbar epidural space, extending from T8 to L5. The patient's symptoms improved within three hours following hospital admission, and after three days without HD treatment, the SSEH decreased in size, and the patient successfully recovered without residual neurological deficits and without requiring surgery. CONCLUSIONS The management of SSEH in patients undergoing HD can be difficult, due to anticoagulation during dialysis and uremia. Prompt diagnosis and close neurological monitoring are important for appropriate management. In patients whose symptoms improve within a short period, conservative management may be considered.
自发性脊髓硬膜外血肿（SSEH）发生于脊髓硬膜外间隙，无创伤或医源性原因，被视为神经急症，因为脊髓受压可能导致神经功能缺损。由于其多样的症状表现，可能类似中风，SSEH的及时诊断可能困难。接受血液透析（HD）的患者因透析期间的抗凝作用和尿毒症而有出血风险。然而，接受HD治疗的患者发生SSEH的情况鲜有报道。病例报告：一名70岁日本男性，既往三年一直接受维持性HD治疗，因急性胸腹痛及完全性截瘫入住日本爱知县刈谷市丰田综合医院。患者否认近期有任何创伤或医疗操作。磁共振成像显示胸段和腰段硬膜外间隙有广泛血肿，从T8延伸至L5。患者入院后三小时内症状改善，在未进行HD治疗三天后，SSEH体积减小，患者成功康复，无残留神经功能缺损且无需手术。结论：由于透析期间的抗凝作用和尿毒症，HD患者SSEH的管理可能困难。及时诊断和密切的神经监测对于恰当管理很重要。对于症状在短时间内改善的患者，可考虑保守治疗。
