Spontaneous Extensive Thoracolumbar Spinal Epidural Hematoma: a complication associated with pharmacological management of non-STelevation myocardial infarction

Hematoma Espinal Epidural Toracolombar Extenso Espontâneo: uma complicação associada ao manejo farmacológico do infarto do miocárdio sem elevação do segmento ST

Carlos Castilla Sarmiento
Jesus García Catoni
Oscar Tilano Molina

https://doi.org/10.22290/jbnc.2025.360114
J Bras Neurocirur 36 (1):111-114, 2025

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Resumo

Apresenta-se o caso de uma mulher de 86 anos, que, após receber tratamento farmacológico e colocação de um stent para NSTEMI, desenvolveu um hematoma espinhal toracolombar espontâneo, uma rara complicação associada ao uso de terapia anticoagulante tripla. A paciente apresentou dor lumbocrural e paraparesia, com diagnóstico confirmado por ressonância magnética. Embora tenha sido considerada a cirurgia, o risco de complicações pós-operatórias era alto, por isso foi escolhida uma abordagem conservadora. Três meses depois, a paciente mostrou melhora parcial de sua função neurológica. Este caso destaca a importância do diagnóstico precoce desta complicação, bem como a necessidade de um tratamento individualizado com base no contexto clínico.

Palavras-chave

NSTEMI; Hematoma epidural espontâneo da coluna vertebral; Aspirina; Heparina de baixo peso molecular; Clopidogrel

Abstract

An 86-year-old woman’s case is presented, who, after receiving pharmacological treatment and stent placement for non-st elevation myocardial infarction (NSTEMI), developed a thoracolumbar spontaneous spinal epidural hematoma (TSSEH), a rare complication associated with the use of triple anticoagulant therapy. The patient presented lumbocrural pain and paraparesis, with a diagnosis confirmed by magnetic resonance (MRI). Although surgery was considered, the risk of postoperative complications was high, so a conservative management approach was chosen. Three months later, the patient showed partial improvement in her neurological function. This case highlights the importance of early diagnosis of this complication as well as the need for individualized treatment based on the clinical context.

Keywords

NSTEMI; Spontaneous spinal epidural hematoma; Aspirin; Low molecular weight heparin; Clopidogrel

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1Department of Medicine, Hospital Universidad del Norte, Barranquilla-Atlántico, Colombia.

2Department of Medicine, Neurosurgery Service, Hospital Universidad del Norte, Barranquilla-Atlántico, Colombia.

3Department of Medicine, Neurosurgery Service, Porto Azul AUNA clinic, Barranquilla-Atlántico, Colombia.

Received Dec 20, 2024

Accepted Jan 7, 2025