Raeouf Armaghan, Goyal Siddarth, Van Horne Nicole, Traylor Jeremy
Department of Medicine, Lake Erie College of Osteopathic Medicine, Erie, USA.
Department of Emergency Medicine, Grandview Medical Center, Dayton, USA.
Cureus. 2020 Sep 12;12(9):e10417. doi: 10.7759/cureus.10417.
A spontaneous spinal epidural hematoma (SSEH) is a rare condition of intraspinal bleeding in the epidural space. It is often associated with disorders of anticoagulation, intraspinal tumors, vascular malformations, and pertinent to this case, anticoagulation therapy. This surgical emergency requires early diagnosis and management in order to minimize permanent neurologic deficits. We report the case of a 72-year-old female with a past medical history of paroxysmal atrial fibrillation treated with rivaroxaban who presented to the emergency department with acute-onset, midline, lower back pain with no known trauma or injury to the area. At the time of emergency department (ED) admission, the patient was fully ambulatory and alert and oriented. However, within hours, she developed bilateral lower extremity motor paralysis and diminished sensation with urinary and bowel incontinence. SSEHs are rare, progressive neurologic emergencies that can present with non-specific lower back pain. This condition presents a diagnostic challenge that can result in permanent neurologic defects if not recognized early. Emergency physicians regularly encounter patients with both acute lower back pain and atrial fibrillation. This case can contribute to the possibility of SSEH to a differential diagnosis.
自发性脊髓硬膜外血肿（SSEH）是一种硬膜外间隙脊髓内出血的罕见病症。它常与抗凝紊乱、脊髓肿瘤、血管畸形有关，且就本病例而言，与抗凝治疗有关。这种外科急症需要早期诊断和处理，以尽量减少永久性神经功能缺损。我们报告一例72岁女性病例，其有阵发性心房颤动病史，接受利伐沙班治疗，因急性发作的中线部位下背部疼痛就诊于急诊科，该部位无已知创伤或损伤。在急诊科入院时，患者可完全自主活动，神志清醒且定向力正常。然而，数小时内，她出现双侧下肢运动麻痹、感觉减退，伴有大小便失禁。SSEH是罕见的、进行性神经急症，可表现为非特异性下背部疼痛。这种病症带来了诊断挑战，如果不及早识别，可能导致永久性神经缺陷。急诊医生经常会遇到同时患有急性下背部疼痛和心房颤动的患者。本病例有助于将SSEH纳入鉴别诊断的可能性。
