Anestesia regional en la paciente embarazada antiagregada o anticoagulada / Regional anesthesia in the antiplatelet or anticoagulated pregnant patient / Anestesia regional em paciente grávida antiplaquetária ou anticoagulada

Resumen: La anestesia regional es la técnica de elección debida a la menor morbimortalidad. Una de las complicaciones más temidas es el hematoma espinal, teniendo las pacientes que reciben antiagregantes y/o anticoagulantes mayor riesgo de desarrollarlo. El cuadro clínico es variable, y no siempre están todos los elementos presentes (dolor lumbar, déficit motor y/o sensitivo y/o vesical). El diagnóstico se realiza por resonancia nuclear magnética y el tratamiento es la descompresión por laminectomía. Estando el pronóstico neurológico vinculado al tiempo en que se realiza ésta. Se realiza una revisión sobre los distintos fármacos antiagregantes y anticoagulantes utilizados en el embarazo - puerperio y las recomendaciones necesarias para las pacientes que recibirán una anestesia regional.

Abstract: Regional anesthesia is the technique of choice due to lower morbidity and mortality. One of the most feared complications is spinal hematoma, with patients receiving antiplatelet and / or anticoagulants having a greater risk of developing it. The clinical picture is variable, and not all the elements are always present (lumbar pain, motor and / or sensory and / or bladder deficits). Diagnosis is made by magnetic resonance imaging and treatment is laminectomy decompression. Being the neurological prognosis linked to the time in which it is performed. A review is made of the different antiplatelet and anticoagulant drugs used in pregnancy - puerperium and the necessary recommendations for patients who will receive regional anesthesia.

Resumo: A anestesia regional é a técnica de escolha devido à menor morbimortalidade. Uma das complicações mais temidas é o hematoma espinhal, com pacientes em uso de antiagregantes plaquetários e / ou anticoagulantes com maior risco de desenvolvê-lo. O quadro clínico é variável e nem sempre os elementos estão presentes (dor lombar, déficits motores e / ou sensoriais e / ou vesicais). O diagnóstico é feito por ressonância magnética e o tratamento é a descompressão por laminectomia. Sendo o prognóstico neurológico ligado ao tempo em que é realizado. É feita uma revisão das diferentes drogas antiplaquetárias e anticoagulantes utilizadas na gravidez - puerpério e as recomendações necessárias para as pacientes que receberão anestesia regional.

Iatrogenic Spinal Subarachnoid Hematoma after Diagnostic Lumbar Puncture

Spinal subarachnoid hematoma (SSH) following diagnostic lumbar puncture is very rare. Generally, SSH is more likely to occur when the patient has coagulopathy or is undergoing anticoagulant therapy. Unlike the usual complications, such as headache, dizziness, and back pain at the needle puncture site, SSH may result in permanent neurologic deficits if not properly treated within a short period of time. An otherwise healthy 43-year-old female with no predisposing factors presented with fever and headache. Diagnostic lumbar puncture was performed under suspicion of acute meningitis. Lumbar magnetic resonance imaging was performed due to hypoesthesia below the level of T10 that rapidly progressed after the lumbar puncture. SSH was diagnosed, and high-dose steroid therapy was started. Her neurological symptoms rapidly deteriorated after 12 hours despite the steroids, necessitating emergent decompressive laminectomy and hematoma removal. The patient’s condition improved after the surgery from a preoperative motor score of 1/5 in the right leg and 4/5 in the left leg to brace-free ambulation (motor grade 5/5) 3-month postoperative. The patient was discharged with no neurologic deficits. Critical complications such as SSH can be fatal. Therefore, a patient undergoing lumbar puncture must be carefully observed. A hematoma that convincingly compresses the spinal cord or cauda equina on imaging results requires early surgical decompression and hematoma removal.

Hematoma subdural espinal. Reporte de caso / Spinal subdural hematoma. Case report

RESUMEN Los hematomas intraraquídeos espontáneos o secundarios a trauma, anticoagulación o procedimientos invasivos a nivel del raquis son muy poco frecuentes. Dentro de estos, se pueden identificar hematomas extradurales o subdurales, siendo estos los menos frecuentes de todos. Los autores presentan un caso clínico de una paciente anticoagulada que desarrolló un hematoma subdural espinal. La paciente se opero en paraplejía, con mala evolución posterior. Se destaca lo poco frecuente de este tipo de hematomas, que tiene una presentación clínica variable. Se debe tener un alto índice de sospecha para su diagnóstico y tratamiento precoz, dado que el pronóstico funcional del paciente depende de su evacuación temprana.

ABSTRACT Spontaneous or secondary spinal haematomas are very rare. Within these, they can be identified extradural or subdural hematomas, which are the least common of all. The authors present a clinical case of an anticoagulated patient who developed a spinal subdural haematoma. The patient was operated in paraplegia, with poor subsequent evolution. We highlights how rare this type of lesions, which has a variable clinical presentation. It should have a high index of suspicion for early diagnosis and treatment, because the patient's functional prognosis depends on early evacuation.

Acute Cervical Subdural Hematoma with Quadriparesis after Cervical Transforaminal Epidural Block

Cervical epidural steroid injection is frequently used in the conservative management of neck pain and cervical radiculopathy. Epidural cervical transforaminal injections are usually well-tolerated with mild side effects such as transient decreased sensory and motor function, or headache due to dural puncture. Although there are a few case reports about adverse effects of cervical epidural injection in the literature, it can cause severe complications such as large hematoma, infarction by spinal vascular injury. Subdural hematoma has been occurred much less common rather than epidural hematoma in the spinal cord. We report a rare catastrophic case of cervical spinal subdural hematoma with quadriparesis after cervical transforaminal epidural block.

Whole Spontaneous Spinal Epidural Hematoma

A 26-year-old male who had no underlying disease, including coagulopathy, underwent thoracotomy and bleeding control due to hemothorax. On the fifth postoperative day, paralysis of both lower limbs occurred. Urgent spine magnetic resonance imaging showed a massive anterior spinal epidural hematoma from C2 to L1 level with different signal intensities, which was suspected to be staged hemorrhage. Hematoma evacuation with decompressive laminectomy was performed. The patient's neurologic deterioration was recovered immediately, and he was discharged without neurological deficits. A drug history of naftazone, which could induce a drug-induced platelet dysfunction, was revealed retrospectively. To our knowledge, this is the first report of whole spontaneous spinal epidural hematoma in a young patient, with a history of hemorrhoid medication.

Paraplegia Due to Spinal Hematoma in a Patient with Acute Lymphocytic Leukemia: A case report

Intrathecal administration of methotrexate is one of the standard therapies in the acute lymphocytic leukemia (ALL). Spinal puncture and tapping for intrathecal administration of methotrexate is considered as a routine procedure but this procedure carries risks of spinal hematoma in ALL patients. Spinal hematoma after spinal puncture is an uncommon condition, but it can occur more often in patients with thrombocytopenic or coagulation disorder. We report 4 year-4 month-old boy of ALL with spinal hematoma leading to paraplegia following lumbar puncture for intrathecal methotrexate treatment.

Chronic Spinal Subdural Hematoma in Infants: Case Report

Spinal subdural hematoma is an uncommon entity having a higher incidence in patients with bleeding diathesis or receiving anticoagulant therapy. Lumbar puncture should be done meticulously especially in patients with a bleeding tendency. Spinal subdural hematoma should be considered as a possible diagnosis in patients with coagulopathy, having sustained a minor trauma, or having had a recent lumbar puncture, showing progressive neurological deficits suggestive of a spinal disorder. In such patients, early diagnosis and proper treatment is imperative in order to minimize any neurological sequelae. We report a case of a 7-month-old infant in a septic condition diagnosed with chronic spinal subdural hematoma that had occurred following repeated lumbar punctures.