Gomes Patrícia A, Cernadas Eduardo, Sá Juliana, Brito Helena, Costa Ricardo
Internal Medicine Department, Centro Hospitalar Cova da Beira, EPE, Covilhã, Portugal.
Emergency Department, Centro Hospitalar Cova da Beira, Covilhã, Portugal.
Eur J Case Rep Intern Med. 2018 Dec 27;5(12):000887. doi: 10.12890/2018_000887. eCollection 2018.
Spinal cord haematoma, or haematomyelia, is a rare condition caused by several unusual disease processes. Traumatic events, such as spinal cord injury and surgery or procedures involving the spinal cord, are the most important causes of spinal cord haematoma. Rarely, it is associated with anticoagulation therapy. Irrespective of cause, spinal cord haematoma is considered a neurosurgical emergency and must be treated promptly in order to prevent neurological sequelae. The authors describe the case of a 69-year-old patient taking warfarin in the therapeutic range for a mechanic mitral valve, who developed chest pain with cervical and dorsal radiation, and experienced sudden paraparesis of the limbs. A CT of the spine confirmed haematomyelia. A high index of suspicion, prompt recognition and immediate intervention are essential to prevent major morbidity and mortality from intraspinal haemorrhage.
This article reports an unusual presentation of spontaneous spinal haematoma, imposing the careful elaboration of differential diagnoses, which is very important in internal medicine.The description of this low-incidence case allows the scientific community to assist in approaching patients with similar symptoms.The lack of studies about the etiology and treatment of spontaneous spinal haematoma underlines the need for further studies and research in the area in order to increase the scientific evidence on the approach of these patients.
脊髓血肿，即脊髓出血，是一种由多种罕见疾病过程引起的病症。创伤性事件，如脊髓损伤、手术或涉及脊髓的操作，是脊髓血肿的最重要原因。极少数情况下，它与抗凝治疗有关。无论病因如何，脊髓血肿都被视为神经外科急症，必须及时治疗以预防神经后遗症。作者描述了一名69岁因机械二尖瓣置换服用治疗剂量华法林的患者，该患者出现伴有颈部和背部放射性疼痛的胸痛，并突然出现双下肢轻瘫。脊柱CT证实为脊髓出血。高度的怀疑指数、及时的识别和立即的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。
本文报道了自发性脊髓血肿的一种不寻常表现，强调了在内科中仔细进行鉴别诊断的重要性。对这个低发病率病例的描述有助于科学界对有类似症状的患者进行诊治。关于自发性脊髓血肿的病因和治疗缺乏研究，这突出了该领域进一步研究的必要性，以便增加对这些患者治疗方法的科学依据。
