Background Context: Spontaneous spinal hematoma (SSH) after low-molecular-weight heparin (LMWH) therapy is a rare cause of compressive myelopathy with neurological deficit. Emergent surgical decompression is commonly advocated for optimal neurological recovery. Only three cases of spontaneous spinal subdural hematomas after LMWH therapy have been reported in the literature, and this is the first report of a spontaneous cervical epidural hematoma (EDH).
Purpose: To highlight the importance of conservative management in an unusual case of cervical EDH with neurological deficit after LMWH therapy.
Study Design: Clinical case report.
Methods: A 65-year-old man presented with weakness of upper and lower limbs with bowel and bladder dysfunction after LMWH therapy for an acute coronary syndrome. Magnetic resonance imaging (MRI) revealed an anterior cervical EDH extending from C4 to T1 with significant cord compression. Associated comorbidities precluded emergent surgical intervention, and the patient was managed conservatively with cessation of LMWH therapy.
Results: The patient showed signs of early neurological recovery within 24 hours (ASIA C [American Spinal Injury Association] to ASIA D) of cessation of LMWH, and hence surgery was deferred. Complete motor and sensory recovery was observed at 1-month follow up with resolution of the cervical EDH without any cord compression evident on the MRI.
Conclusions: LMWH therapy is an important cause of SSH leading to significant neurological deficits. Conservative management is a viable treatment option in patients who demonstrate early and sustained neurological recovery with the cessation of LMWH therapy.
Download full-text PDF |
Source |
---|---|
http://dx.doi.org/10.1016/j.spinee.2010.04.011 | DOI Listing |
Enoxaparin sodium is a low molecular mass heparin essential for effective anticoagulation therapy. However, significant variations in testing methods across different manufacturers have led to poor reproducibility of results, increasing the risks associated with drug quality evaluation by manufacturers and regulatory oversight. This study integrates the strengths of various testing methods to establish a reproducible assay that has been thoroughly validated.
View Article and Find Full Text PDFGastroenterology
December 2024
Division of Gastroenterology and Hepatology, Department of Medicine, Endeavor Health, Chicago, Illinois.
Description: Portal vein thromboses (PVTs) are common in patients with cirrhosis and are associated with advanced portal hypertension and mortality. The treatment of PVTs remains a clinical challenge due to limited evidence and competing risks of PVT-associated complications vs bleeding risk of anticoagulation. Significant heterogeneity in PVT phenotype based on anatomic, host, and disease characteristics, and an emerging spectrum of therapeutic options further complicate PVT management.
View Article and Find Full Text PDFHarefuah
December 2024
Internal Medicine F Department, Wolfson UMC Holon.
Massive pulmonary embolism (PE) is a life threatening condition with age-related escalation in prevalence. Acute PE is a common and sometimes fatal disease. The approach to the evaluation should be efficient while simultaneously avoiding the risks of unnecessary testing so that therapy can be promptly initiated and potential morbidity and mortality avoided.
View Article and Find Full Text PDFBeijing Da Xue Xue Bao Yi Xue Ban
December 2024
Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, China.
Hereditary protein S deficiency (PSD) is an autosomal dominant disorder caused by mutations in the 1 gene which can cause venous thrombosis. Individuals with PSD usually present with recurrent deep vein thrombosis and/or pulmonary embolism, but thrombosis may occur at unusual sites, such as the mesenteric and portal veins. Here we report a case of hereditary protein S deficiency patient with predominant mesenteric venous thrombosis.
View Article and Find Full Text PDFJ Crit Care
December 2024
Departments of Intensive Care Medicine, Gelre Hospitals, Albert Schweitzerlaan 31, 7334, DZ, Apeldoorn, the Netherlands; Departments of Expertise Centre for Intensive Care Rehabilitation Apeldoorn - ExpIRA, Gelre Hospitals, Albert Schweitzerlaan 31, 7334, DZ, Apeldoorn, the Netherlands; Department of Intensive Care Medicine, University Medical Center, Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.
Purpose: Low-molecular-weight heparins (LMWHs) are widely used for prevention and treatment of venous thromboembolism (VTE) in critically ill patients. The objective of this study was to assess the dose-response relationship between nadroparin dose and anti-Xa activity in ICU patients.
Materials And Methods: Critically ill adult patients who were admitted to the ICU, and received at least three subcutaneous injections of nadroparin were included.
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!