Mielopatia induzida por medicação anticoagulante: relato de um caso com hematoma epidural espinhal

Werneck, Lineu Cesar; Araujo, João Cândido; Rachid, Acir

doi:10.1590/S0004-282X1982000400006

Resumos

Relato do caso de uma paciente de 51 anos de idade, recebendo anticoagulante por tromboflebite e embolias pulmonares, com tempo de atividade de protrombina dentro do limite terapêutico, que desenvolveu súbita paraplegia. A investigação revelou bloqueio medular e a cirurgia comprovou ser um hematoma epidural espinhal, que foi evacuado. A paciente permaneceu com os mesmos déficits clínicos no post-operatório. São feitos comentários a respeito da etiologia dos hematomas espinhais epidurals, sua patogenia, etiologia e chamada a atenção para o pronto diagnóstico e tratamento cirúrgico.

A 51 year-old female patient, under anticoagulant therapy due to thrombophebitis and pulmonary embolism, developped sudden paraplegia. Emergency myelogram showed a total block at L2 level and an epidural hematoma was removed at surgery, but the motor deficit remained unchanged postoperatively. The pertinent literature is reviewed, etiological considerations are made and emphasis is placed on early diagnosis and prompt treatment.

Mielopatia induzida por medicação anticoagulante: relato de um caso com hematoma epidural espinhal

Myelopathy induced by anticoagulant: report of a case with spinal epidural hematoma

Lineu Cesar Werneck^I; João Cândido Araujo^II; Acir Rachid^III

^IProfessor Assistente (Neurologia). Departamento de Clínica Médica da Universidade Federal do Paraná

^IIIProfessor Assistente (Neurocirurgia). Departamento de Clínica Médica da Universidade Federal do Paraná

^IIIProfessor Titular (Reumatologia). Departamento de Clínica Médica da Universidade Federal do Paraná

RESUMO

Relato do caso de uma paciente de 51 anos de idade, recebendo anticoagulante por tromboflebite e embolias pulmonares, com tempo de atividade de protrombina dentro do limite terapêutico, que desenvolveu súbita paraplegia. A investigação revelou bloqueio medular e a cirurgia comprovou ser um hematoma epidural espinhal, que foi evacuado. A paciente permaneceu com os mesmos déficits clínicos no post-operatório. São feitos comentários a respeito da etiologia dos hematomas espinhais epidurals, sua patogenia, etiologia e chamada a atenção para o pronto diagnóstico e tratamento cirúrgico.

SUMMARY

A 51 year-old female patient, under anticoagulant therapy due to thrombophebitis and pulmonary embolism, developped sudden paraplegia. Emergency myelogram showed a total block at L2 level and an epidural hematoma was removed at surgery, but the motor deficit remained unchanged postoperatively. The pertinent literature is reviewed, etiological considerations are made and emphasis is placed on early diagnosis and prompt treatment.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Trabalho realizado na Disciplina de Neurologia do Departamento de Clínica Médica da Universidade Federal do Paraná.

Disciplina de Neurologia, Departamento de Clínica Médica - Hospital de Clínicas da Universidade Federal do Paraná - Rua General Carneiro, 180, 13º andar - 80000 Curitiba, PR - Brasil.

1. BRAMFORD, C. R. - Spinal epidural hematoma due to heparin. Arch. Neurol. (Chicago) 35:693, 1978.
2. BREM, S. S.; HAFLER, D. A.; UITERT, R. L.; RUFF, R. L. & REICHERT, W. H. - Spinal subarachnoid hematoma. A hazard of lumbar puncture resulting in reversible paraplegia. New Engl. J. Med. 303:1020, 1981.
3. CORREA, A. V. & BEASLEY, B. A. - Spontaneous cervical epidural hematoma with complete recovery. Surg. Neurol. 10:277, 1978.
4. CROMWELL, L. D.; KERBER, C. & FERRY, P. C. - Spinal cord compression in a hemophiliac infant. Am. J. Roentgenol. 128:847, 1977.
5. DULAG, O.; AICARDI, J.; LEPINTRE, J. & KARRIAU, P. - Hematome epi-dural intra-rachidien apres ponction lombaire. Arch. Franç. Péd. 32:77, 1975.
6. DUNN, D.; DHOPESH, V. & MOBINI, J. - Spinal subdural hematoma. A possible hazard of lumbar puncture in an alcoholic. J. A. M. A. 241:1712, 1979.
7. EDELSON, R. N.; CHERNIK, N. L. & POSNER, J. B. - Spinal subdural hematoma complicating lumbar puncture. Ocurrence in thrombocytopenic patients. Arch. Neurol. (Chicago) 31:134, 1974.
8. GALZIO, R. J.; ZENOBII, M. & D'ECCLESIA, G. - Spontaneous spinal epidural hematoma: Report of a case with complete recovery. Surg. Neurol. 14:263, 1980.
9. GHANEM, Q. & IVAN, L. P. - Spontaneous spinal epidural hematoma in a 8-year-old boy. Neurology(Ny) 28:829, 1978.
10. HORNE, J. G. & MULLER, P. - Spontaneous spinal extradural hematoma. Can. J. Surg. 20:379, 1977.
11. HURT, R. W.; SHAW, M. D. M. & RUSSELL, J. A. - Spinal sub-dural haematoma: An unusual complication of lumbar puncture. Surg. Neurol. 8:296, 1977.
12. KOSARY, I. Z.; BRAHAM, J.; SHACKED, I. & SHACKED, R. - Spinal epidural hematoma due to hemangiome of vertebra. Surg. Neurol. 7:61, 1977.
13. LAGLIA, A. G.; EISENBERG, R. L.; WEINSTEIN, P. R. & MANI, R. L. - Spinal epidural hematoma after lumbar puncture in liver disease. Ann. Int. Med. 88:515, 1978.
14. LOCKE, G. E.; GIORGIO, A. J.; BIGGERS, S. L.; JOHNSON, A. P. & SALEM, F. - Acute spinal epidural hematoma secondary to aspirin-induced prolonged bleeding. Surg. Neurol. 5:293, 1976.
15. LONDON, G. W.; McKEEVER, P. E. & WIEDERHOLT, W. C. - Spontaneous spinal epidural hematoma in alcoholism. Ann. Int. Med. 81:266, 1974.
16. MASDEU, J. C.; BREUER, A. C. & SHOENE, W. C. - Spinal sub-arachnoid hematoma: Clue to source of bleeding in traumatic lumbar puncture. Neurology (Ny) 29:872, 1979.
17. MESSER, H. D.; FORSHAN, V. R.; BRUST, J. C. & HIGHES, J. E. O. - Transient paraplegia from hematoma after lumbar puncture. A consequence of anticoagulant therapy. J. A. M. A. 235:529, 1976.
18. PETROV, V.; COLLIGNON, J. & STEVENAERT, A. - Hématomes spinaus extra-duraux et sous-duraux au cours d'une traitment par anticoagulants. Acta Neurol. Bel. 79:398, 1979.
19. POINTUED, P.; UZZAN, B. & STILHART, B. - Syndrome de la quene de cheval par hématome épidural rachidien au cours d'un traitment anticoagulant. La Nouvelle Presse Médicale 8:4047, 1979.
20. SILVERSTEIN, A. - Neurological complications of anticoagulantion therapy. A neurologist's review. Arch. Inter. Med. 139:217, 1979.
21. VALLEE, B.; BESSON, G.; GARRE, H.; MONNERIE, J. L. & GUYADER, J. - Hématome sous-dural aigu rachidien à la reprise d'un traitment anticoagulant, interrompu pour ponction lombaire. La Nouvelle Presse Médicale 9:3457, 1980.
22. VAPALAHTI, M. & KUURNE, T. - Acute paraplegia caused by a spontaneous extradural haematoma of the conus medullaris area. Acta. Chir. Scand. 141:484, 1975.
23. VINTERS, H. V.; BARNETT, H. J. M. & KAUFMANN, J. C. - Sub-dural hematoma of the spinal cord and widespread subarachnoid hemorrhage complicating anticoagulant therapy. Stroke 11:459, 1980.
24. WOOLF, J. I. - Lumbar puncture and anticoagulant therapy. J. A. M. A. 235:2716, 1976.
25. YONEKAWA, Y.; MEHDORN, H. M. & NISHIKAWA, M. - Spontaneous spinal epidural hematoma during pregnancy. Surg. Neurol. 3:327, 1975.

Datas de Publicação

Publicação nesta coleção
15 Ago 2012
Data do Fascículo
Dez 1982

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. BRAMFORD, C. R. - Spinal epidural hematoma due to heparin. Arch. Neurol. (Chicago) 35:693, 1978.

[2] 2. BREM, S. S.; HAFLER, D. A.; UITERT, R. L.; RUFF, R. L. & REICHERT, W. H. - Spinal subarachnoid hematoma. A hazard of lumbar puncture resulting in reversible paraplegia. New Engl. J. Med. 303:1020, 1981.

[3] 3. CORREA, A. V. & BEASLEY, B. A. - Spontaneous cervical epidural hematoma with complete recovery. Surg. Neurol. 10:277, 1978.

[4] 4. CROMWELL, L. D.; KERBER, C. & FERRY, P. C. - Spinal cord compression in a hemophiliac infant. Am. J. Roentgenol. 128:847, 1977.

[5] 5. DULAG, O.; AICARDI, J.; LEPINTRE, J. & KARRIAU, P. - Hematome epi-dural intra-rachidien apres ponction lombaire. Arch. Franç. Péd. 32:77, 1975.

[6] 6. DUNN, D.; DHOPESH, V. & MOBINI, J. - Spinal subdural hematoma. A possible hazard of lumbar puncture in an alcoholic. J. A. M. A. 241:1712, 1979.

[7] 7. EDELSON, R. N.; CHERNIK, N. L. & POSNER, J. B. - Spinal subdural hematoma complicating lumbar puncture. Ocurrence in thrombocytopenic patients. Arch. Neurol. (Chicago) 31:134, 1974.

[8] 8. GALZIO, R. J.; ZENOBII, M. & D'ECCLESIA, G. - Spontaneous spinal epidural hematoma: Report of a case with complete recovery. Surg. Neurol. 14:263, 1980.

[9] 9. GHANEM, Q. & IVAN, L. P. - Spontaneous spinal epidural hematoma in a 8-year-old boy. Neurology(Ny) 28:829, 1978.

[10] 10. HORNE, J. G. & MULLER, P. - Spontaneous spinal extradural hematoma. Can. J. Surg. 20:379, 1977.

[11] 11. HURT, R. W.; SHAW, M. D. M. & RUSSELL, J. A. - Spinal sub-dural haematoma: An unusual complication of lumbar puncture. Surg. Neurol. 8:296, 1977.

[12] 12. KOSARY, I. Z.; BRAHAM, J.; SHACKED, I. & SHACKED, R. - Spinal epidural hematoma due to hemangiome of vertebra. Surg. Neurol. 7:61, 1977.

[13] 13. LAGLIA, A. G.; EISENBERG, R. L.; WEINSTEIN, P. R. & MANI, R. L. - Spinal epidural hematoma after lumbar puncture in liver disease. Ann. Int. Med. 88:515, 1978.

[14] 14. LOCKE, G. E.; GIORGIO, A. J.; BIGGERS, S. L.; JOHNSON, A. P. & SALEM, F. - Acute spinal epidural hematoma secondary to aspirin-induced prolonged bleeding. Surg. Neurol. 5:293, 1976.

[15] 15. LONDON, G. W.; McKEEVER, P. E. & WIEDERHOLT, W. C. - Spontaneous spinal epidural hematoma in alcoholism. Ann. Int. Med. 81:266, 1974.

[16] 16. MASDEU, J. C.; BREUER, A. C. & SHOENE, W. C. - Spinal sub-arachnoid hematoma: Clue to source of bleeding in traumatic lumbar puncture. Neurology (Ny) 29:872, 1979.

[17] 17. MESSER, H. D.; FORSHAN, V. R.; BRUST, J. C. & HIGHES, J. E. O. - Transient paraplegia from hematoma after lumbar puncture. A consequence of anticoagulant therapy. J. A. M. A. 235:529, 1976.

[18] 18. PETROV, V.; COLLIGNON, J. & STEVENAERT, A. - Hématomes spinaus extra-duraux et sous-duraux au cours d'une traitment par anticoagulants. Acta Neurol. Bel. 79:398, 1979.

[19] 19. POINTUED, P.; UZZAN, B. & STILHART, B. - Syndrome de la quene de cheval par hématome épidural rachidien au cours d'un traitment anticoagulant. La Nouvelle Presse Médicale 8:4047, 1979.

[20] 20. SILVERSTEIN, A. - Neurological complications of anticoagulantion therapy. A neurologist's review. Arch. Inter. Med. 139:217, 1979.

[21] 21. VALLEE, B.; BESSON, G.; GARRE, H.; MONNERIE, J. L. & GUYADER, J. - Hématome sous-dural aigu rachidien à la reprise d'un traitment anticoagulant, interrompu pour ponction lombaire. La Nouvelle Presse Médicale 9:3457, 1980.

[22] 22. VAPALAHTI, M. & KUURNE, T. - Acute paraplegia caused by a spontaneous extradural haematoma of the conus medullaris area. Acta. Chir. Scand. 141:484, 1975.

[23] 23. VINTERS, H. V.; BARNETT, H. J. M. & KAUFMANN, J. C. - Sub-dural hematoma of the spinal cord and widespread subarachnoid hemorrhage complicating anticoagulant therapy. Stroke 11:459, 1980.

[24] 24. WOOLF, J. I. - Lumbar puncture and anticoagulant therapy. J. A. M. A. 235:2716, 1976.

[25] 25. YONEKAWA, Y.; MEHDORN, H. M. & NISHIKAWA, M. - Spontaneous spinal epidural hematoma during pregnancy. Surg. Neurol. 3:327, 1975.