ABSTRACT
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Subject(s)
Humans , Male , Adult , Angiography/adverse effects , Angiography , Angiography/methods , Interferon beta-1a/administration & dosage , Interferon beta-1a/adverse effects , Adrenal Cortex Hormones/therapeutic use , Multiple Sclerosis/complications , Gemfibrozil/therapeutic use , Lithium/therapeutic use , Dyspnea/complications , Thrombocytopenia/complicationsSubject(s)
Interferon beta-1a/adverse effects , Thrombotic Microangiopathies/chemically induced , Adult , Humans , Injections, Subcutaneous , Interferon beta-1a/administration & dosage , Male , Multiple Sclerosis, Relapsing-Remitting/complications , Multiple Sclerosis, Relapsing-Remitting/drug therapy , Psychotic Disorders/drug therapy , Psychotic Disorders/etiology , Thrombotic Microangiopathies/complicationsABSTRACT
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Subject(s)
Humans , Female , Aged , Hyperglycemia/physiopathology , Diabetic Ketoacidosis/physiopathology , Epilepsy, Partial, Motor/etiology , Magnetic Resonance Spectroscopy/methodsABSTRACT
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Subject(s)
Humans , Spinal Puncture/adverse effects , Iatrogenic Disease , Hematoma, Subdural, Spinal/etiologyABSTRACT
INTRODUCTION: Spinal cord hematoma is a serious and feared complication of lumbar puncture. We here describe two patients who developed a spinal cord hematoma following diagnostic lumbar punctures. CASE REPORTS: CASE 1: a 22-year-old male with a syndrome of cerebrospinal fluid hypotension, with normal coagulation parameters, underwent a traumatic, diagnostic lumbar puncture followed, a few hours later, by back pain irradiated to the legs. MRI showed the presence of a subdural hematoma from the lower dorsal region to the sacral region. A conservative approach, without surgery, was decided and he showed a complete recovery. CASE 2: a 69-year-old woman underwent a diagnostic lumbar puncture for the study of recent-onset headache with tinnitus and unstable gait. Puncture was traumatic and cerebrospinal fluid was normal. A few hours later, she complained of back pain and sciatica, and examination revealed a bilateral Lassegue sign. She required urinary catheterization. MRI showed an epidural hematoma from the T10 vertebra to the sacral area. Her outcome with a conservative approach was also excellent. CONCLUSIONS: Spinal cord hematomas can occur after a traumatic lumbar puncture in people without coagulation disorders or any other predisposing factor. Although surgery has been traditionally advocated in these cases, a conservative approach is an option when symptoms are mild and a close follow-up is possible.
Subject(s)
Hematoma, Subdural, Spinal/etiology , Spinal Cord Vascular Diseases/etiology , Spinal Cord , Spinal Puncture/adverse effects , Aged , Female , Hematoma, Subdural, Spinal/pathology , Humans , Male , Postoperative Complications , Recovery of Function , Spinal Cord/pathology , Spinal Cord/surgery , Spinal Cord Vascular Diseases/pathology , Young AdultABSTRACT
Introducción. El hematoma espinal es una grave complicación de la punción lumbar. Se muestran los casos de dos pacientes que presentaron hematomas espinales tras la práctica de punciones lumbares diagnósticas. Casos clínicos. Caso 1. Varón de 22 años, con hipotensión de líquido cefalorraquídeo y estudio de coagulación normal. Se le realizó una punción lumbar que fue traumática y en las siguientes horas desarrolló dolor lumbar con irradiación radicular. En la resonancia magnética se detectó la existencia de un hematoma subdural desde la región dorsal baja hasta la región sacra. El tratamiento fue conservador, sin cirugía, con una excelente evolución. Caso 2. Mujer de 69 años a quien se le realizó una punción lumbar diagnóstica para el estudio de una cefalea de reciente comienzo con acúfenos e inestabilidad. La punción lumbar fue traumática, y se obtuvo un líquido cefalorraquídeo normal. Horas después presentó dolor lumbar con irradiación radicular. En la exploración se apreció un signo de Lassegue positivo y precisó sondaje urinario. En la resonancia magnética se observó un hematoma epidural desde D10 hasta la región sacra. Su evolución, tratada de forma conservadora, también fue satisfactoria. Conclusiones. Las punciones lumbares traumáticas favorecen el desarrollo de hemorragias espinales en pacientes sin coagulopatías u otros factores de predisposición. Aunque en estos casos se ha recomendado un tratamiento quirúrgico, la actitud terapéutica puede ser conservadora cuando el cuadro clínico sea menor y se garantice un estrecho seguimiento (AU)
Introduction. Spinal cord hematoma is a serious and feared complication of lumbar puncture. We here describe two patients who developed a spinal cord hematoma following diagnostic lumbar punctures. Case reports. Case 1: a 22-year-old male with a syndrome of cerebrospinal fluid hypotension, with normal coagulation parameters, underwent a traumatic, diagnostic lumbar puncture followed, a few hours later, by back pain irradiated to the legs. MRI showed the presence of a subdural hematoma from the lower dorsal region to the sacral region. A conservative approach, without surgery, was decided and he showed a complete recovery. Case 2: a 69-year-old woman underwent a diagnostic lumbar puncture for the study of recent-onset headache with tinnitus and unstable gait. Puncture was traumatic and cerebrospinal fluid was normal. A few hours later, she complained of back pain and sciatica, and examination revealed a bilateral Lassegue sign. She required urinary catheterization. MRI showed an epidural hematoma from the T10 vertebra to the sacral area. Her outcome with a conservative approach was also excellent. Conclusions. Spinal cord hematomas can occur after a traumatic lumbar puncture in people without coagulation disorders or any other predisposing factor. Although surgery has been traditionally advocated in these cases, a conservative approach is an option when symptoms are mild and a close follow-up is possible (AU)
Subject(s)
Humans , Spinal Puncture/adverse effects , Hemorrhage/etiology , Spinal Injuries/etiology , Iatrogenic Disease , Lumbosacral Region/injuries , Risk Factors , Informed Consent , Hemorrhagic Disorders/complications , Magnetic Resonance SpectroscopyABSTRACT
Unlike most other coagulation factor deficiencies, usually associated with abnormal bleeding, lack of factor XII (Hageman) can result in thromboembolic events as a result of a deficient fibrinolytic system. We report a patient with an ischemic stroke and factor XII deficiency, a rare hereditary disorder. The optimal therapy for these uncommon disorders is not well established, but they probably require long term anticoagulation to prevent subsequent thrombotic events.
Subject(s)
Brain Ischemia/etiology , Factor XII Deficiency/complications , Aged , Anticoagulants/therapeutic use , Brain Ischemia/diagnosis , Brain Ischemia/drug therapy , Heparin/therapeutic use , Humans , MaleABSTRACT
A diferencia de la mayoría de los déficit de factores de la coagulación, que habitualmente cursan con hemorragia, la ausencia de factor XII (Hageman) puede dar lugar a fenómenos tromboembólicos como resultado de un sistema fibrinolítico deficitario. Se describe a un paciente con un infarto cerebral asociado a un déficit de factor XII, un trastorno hereditario infrecuente. El tratamiento idóneo de estas enfermedades tan poco comunes no está bien establecido, aunque pueden requerir anticoagulación a largo plazo para prevenir posteriores episodios tromboembólicos. (AU)
