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Massive psoas haematoma causing lumbar plexus palsy: a case report.
Xavier Conesa1, Oscar Ares, Roberto Seijas
1Department of Traumatology and Orthopaedic Surgery, Hospital Municipal de Badalona, Barcelona, Spain.
Journal of Orthopaedic Surgery (Hong Kong)
|April 27, 2012
Summary
A massive psoas hematoma caused lumbar plexus palsy in an elderly man on anticoagulation. Conservative management led to no neurological recovery, highlighting the need for high diagnostic suspicion for insidious deficits.
Area of Science:
- Neurology
- Vascular Surgery
Background:
- Elderly patients on anticoagulation therapy are at risk for spontaneous bleeding events.
- Psoas hematomas can cause significant neurological deficits due to compression of the lumbar plexus.
Observation:
- An 84-year-old male on oral anticoagulation presented with complete lumbar plexus palsy.
- A large psoas hematoma was identified as the cause of the neurological deficit.
Findings:
- Conservative management was chosen over surgical drainage due to high risks of bleeding complications and mortality.
- No neurological recovery was observed at the one-year follow-up.
- The patient ultimately died from unrelated medical issues.
Implications:
- This case underscores the importance of maintaining a high index of suspicion for psoas hematoma in patients with unexplained, progressive neurological deficits, especially those on anticoagulation.
- Delayed diagnosis and management of psoas hematomas can lead to irreversible neurological damage.
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