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Fatal spontaneous spinal epidural hematoma following thrombolysis for myocardial infarction
J E Cohen1, H J Ginsberg, D Emery
1Departmento de Neurocirugia, Hospital de Emergencias Dr Clemente Alvarez, Universidad Nacional de Rosario, Argentina.
Background:
This is the first communication of a fatal spontaneous spinal epidural hematoma following thrombolysis.
Clinical Presentation:
Spine pain may precede neurologic deterioration by many hours. The diagnosis can be accurately made with axial computed tomography (CT) of the involved spinal segment.
Treatment:
Emergency surgery is the treatment for this condition, but conditions such as the acute stage of a myocardial infarction or intraoperative bleeding difficulties due to iatrogenic coagulopathy, the degree of preoperative neurologic deficit, and the timing of surgery must be cautiously considered.
Conclusions:
Neurosurgeons will be faced with another devastating complication of thrombolytic therapy, as long as the available drugs are being used. Early clinical suspicion and availability of CT or magnetic resonance imaging for prompt diagnosis are essential to initiate appropriate medical therapy and timely surgery. New strategies must include the development of completely fibrin-specific thrombolytics and drugs that may rapidly reverse the systemic and local clotting disorder.