Epidural Hematoma after the Use of Subcutaneous Unfractionated Heparin and History of Epidural Tumor
Epidural Hematoma after the Use of Subcutaneous Unfractionated Heparin and History of Epidural Tumor作者机构：Department of Anesthesiology Loyola University Medical Center Maywood IL USA
出 版 物：《Open Journal of Anesthesiology》 (麻醉学期刊（英文）)
年 卷 期：2014年第4卷第7期
页 面：163-166页
学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学]
主 题：Epidural Hematoma Epidural Metastasis Heparin
摘 要：The patient was a 66-year-old male with a history of renal cell carcinoma with metastasis to the L2, L3, and L4 vertebral bodies scheduled for a radical nephrectomy and adrenalectomy. Prior to surgery the patient had undergone 10 radiation treatments for the vertebral metastasis. Patient medications included colace, prednisone, ibuprofen (taken 4 days prior to procedure), sunitinib, hydrocodone, benazepril, nexium, rosuvastatin, allopurinol, and azor. Physical exam prior to surgery was normal with no focal findings. Laboratory values were within normal limits with a platelet count of 286. General anesthesia was planned with a pre-operative thoracic epidural for postoperative analgesia. The epidural was placed at the T9-T10 level without complication. Adequate pain control was present post operatively and the epidural was discontinued on post-operative day 3. At that time the patient was noted to have numbness over the bilateral lower extremities and decreased strength. Heparin 5000 units subcutaneous had been given 12 hours prior to discontinuation of the epidural. The patient was afebrile, hemoglobin was 7, white blood cell count was 9.7, and platelets were 166 at time of epidural removal. Subcutaneous heparin was restarted 6 hours after catheter removal. The anesthesia acute pain service was contacted by the primary service 25 hours after discontinuation of the epidural catheter regarding complaints of persistentbilateral lower extremity weakness and sensory loss. An magnetic resonance image (MRI) revealeda focus posterior to the spinal cord at the T10/T11 interspace likely representing a hematoma. A high intensity T2 signal within the central spinal cord at T10/T11 was also observed;likely a vascular infarct. The patient was immediately scheduled for a T9-T10 laminectomy and evacuation of the epidural hematoma. No significant abnormalities were noted in coagulation studies prior to surgery. The patient was discharged on post-operative day 20 with no neurologic de
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