Spinal epidural hematoma following epidural catheter removal in a paraplegic patient

• Published in: Journal of clinical anesthesia Vol. 21; no. 7; pp. 525 - 528
• Main Authors: Eipe, Naveen, MBBS, MD, Restrepo-Garces, Carlos E., MD, Aviv, Richard I., MD, MRCP, FRCR, Awad, Imad T., MBChB, FCARCSI
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2009; Elsevier; Elsevier Limited
• Subjects: Administration error; Adult; Anesthesia; Anesthesia & Perioperative Care; Anesthesia, Epidural - adverse effects; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anticoagulants; Anticoagulants - adverse effects; Back pain; Biological and medical sciences; Catheterization - adverse effects; Catheters; Complication- Spinal epidural hematoma; Drugs- Anticoagulation; Epidural; Epidural Space - pathology; Fibrinogen - metabolism; Headaches; Hematoma; Hematoma, Epidural, Spinal - etiology; Hematoma, Epidural, Spinal - pathology; Hematoma, Epidural, Spinal - therapy; Heparin - adverse effects; Humans; Injury- Spinal cord; Magnetic Resonance Imaging; Male; Medical sciences; Pain Medicine; Paralysis; Paraplegia; Paraplegia - complications; Patients; Platelet Count; Spinal cord injuries; Subcutaneous unfractionated heparin; Surgery; Technique- Epidural anesthesia- analgesia; Thrombocytopenia; Urinary Bladder, Neurogenic - surgery; Subcutaneous unfractionated heparin; Technique- Epidural anesthesia- analgesia; Administration error; Paraplegia; Drugs- Anticoagulation; Complication- Spinal epidural hematoma; Injury- Spinal cord; Motor system disorder; Catheter; Cardiovascular disease; Extradural hematoma; Anticoagulant; Vascular disease; Extradural; Spinal cord trauma; Anesthesia; Complication; Neurological disorder; Human; Nervous system diseases; Subcutaneous; Analgesia; Central nervous system disease; Glycosaminoglycan; Heparin; Spinal cord disease
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2008.12.020

Abstract Spinal epidural hematoma is a rare and devastating complication of epidural catheter removal in an anticoagulated patient. The diagnosis could be quite challenging, especially in patients with preexisting neurological deficits. A 35-year-old patient with remote spinal cord injury and T4 level paraplegia developed a spinal epidural hematoma on the 7th postoperative day. The hematoma developed after epidural catheter removal with concurrent administration of unfractionated heparin.