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Epidural hematoma with atypical presentation.

Joshua Shroll1, Maged Guirguis, Ajay D'Mello

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Summary
This summary is machine-generated.

A rare spinal epidural hematoma caused a unique motor deficit after surgery. Prompt decompression led to a full recovery without lasting neurological issues.

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Area of Science:

  • Neurosurgery
  • Anesthesiology
  • Gastrointestinal Surgery

Background:

  • Spinal epidural hematomas (SEH) are rare but serious complications.
  • Risk factors include anticoagulation and epidural catheter placement.
  • Atypical presentations can delay diagnosis and treatment.

Purpose of the Study:

  • To report a unique case of SEH with isolated motor deficit.
  • To highlight the importance of timely diagnosis and intervention.
  • To discuss potential contributing factors in the presented case.

Main Methods:

  • Case report of a patient undergoing Collis-Nissen fundoplication.
  • Epidural catheter placement for postoperative pain management.
  • Initiation of subcutaneous unfractionated heparin and ketorolac postoperatively.
  • Diagnosis via thoracic magnetic resonance imaging (MRI).
  • Emergent surgical decompression and hematoma evacuation.

Main Results:

  • The patient developed unilateral motor deficit in the right lower extremity on postoperative day 2.
  • MRI revealed a massive epidural hematoma from T2 to T12.
  • Emergent decompression and evacuation were performed 37 hours after epidural placement.
  • The patient experienced a complete neurological recovery without deficit.

Conclusions:

  • Massive SEH can present atypically with isolated motor deficits.
  • Early recognition and surgical intervention are crucial for favorable outcomes.
  • Careful consideration of anticoagulation and analgesia protocols is necessary in patients with epidural catheters.