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Yue JK, Lee YM, Quintana D, Aabedi AA, Krishnan N, Wozny TA, Andrews JP, Huang MC. Paraparesis caused by intradural thoracic spinal granuloma secondary to organizing hematoma: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22432. [PMID: 36411545 PMCID: PMC9678799 DOI: 10.3171/case22432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/24/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Spinal granulomas form from infectious or noninfectious inflammatory processes and are rarely present intradurally. Intradural granulomas secondary to hematoma are unreported in the literature and present diagnostic and management challenges. OBSERVATIONS A 70-year-old man receiving aspirin presented with encephalopathy, subacute malaise, and right lower extremity weakness and was diagnosed with polysubstance withdrawal and refractory hypertension requiring extended treatment. Seven days after admission, he reported increased bilateral lower extremity (BLE) weakness. Magnetic resonance imaging showed T2-3 and T7-8 masses abutting the pia, with spinal cord compression at T2-3. He was transferred to the authors' institution, and work-up showed no vascular shunting or malignancy. He underwent T2-3 laminectomies for biopsy/resection. A firm, xanthochromic mass was resected en bloc. Pathology showed organizing hematoma without infection, vascular malformation, or malignancy. Subsequent coagulopathy work-up was unremarkable. His BLE strength significantly improved, and he declined resection of the inferior mass. He completed physical therapy and was cleared for placement in a skilled nursing facility. LESSONS Spinal granulomas can mimic vascular lesions and malignancy. The authors present the first report of paraparesis caused by intradural granuloma secondary to organizing hematoma, preceded by severe refractory hypertension. Tissue diagnosis is critical, and resection is curative. These findings can inform the vigilant clinician for expeditious treatment.
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Affiliation(s)
- John K. Yue
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and ,Department of Neurosurgery, Veterans Affairs Medical Center, San Francisco, California
| | - Young M. Lee
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and ,Department of Neurosurgery, Veterans Affairs Medical Center, San Francisco, California
| | - Daniel Quintana
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and ,Department of Neurosurgery, Veterans Affairs Medical Center, San Francisco, California
| | - Alexander A. Aabedi
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and ,Department of Neurosurgery, Veterans Affairs Medical Center, San Francisco, California
| | - Nishanth Krishnan
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and ,Department of Neurosurgery, Veterans Affairs Medical Center, San Francisco, California
| | - Thomas A. Wozny
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and ,Department of Neurosurgery, Veterans Affairs Medical Center, San Francisco, California
| | - John P. Andrews
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and ,Department of Neurosurgery, Veterans Affairs Medical Center, San Francisco, California
| | - Michael C. Huang
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and ,Department of Neurosurgery, Veterans Affairs Medical Center, San Francisco, California
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Brown MW, Yilmaz TS, Kasper EM. Iatrogenic spinal hematoma as a complication of lumbar puncture: What is the risk and best management plan? Surg Neurol Int 2016; 7:S581-9. [PMID: 27625895 PMCID: PMC5009572 DOI: 10.4103/2152-7806.189441] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 02/20/2016] [Indexed: 11/09/2022] Open
Abstract
Background: Lumbar puncture (LP) rarely results in complications such as spinal hematomas. However, it remains unclear if certain variables increase likelihood of these events, or if surgical intervention improves outcome. Methods: In addition to two clinical vignettes, we evaluated the post-1974 literature for cases of spinal hematoma and subsequent intervention. Based on our compilation of data, we evaluated outcome relative to numerous distinct variables. Results: Based on 35 LP-related spinal hematoma cases in the post-1974 literature and our encounters, we found 28.6% of patients presenting with preexisting coagulopathy had poor outcomes regardless of intervention, relative to 14.3% of patients without coagulopathy; a highly significant difference (P = 0.02). Once diagnosed, 21 patients were treated surgically and 14 nonsurgically. Of the 60% surgical patients, 57.1% had good outcomes, and 42.9% had poor outcomes within 12 months. Of 40% nonsurgical patients, 57.1% had good outcomes and 42.9% had poor outcomes. Results in these groups were not statistically different. Conclusions: We found a significant correlation between preexisting coagulopathy and poor neurological outcome irrespective of intervention. However, outcomes for these patients may be confounded by comorbidities including underlying conditions contributing to their coagulopathy. No significant correlation between type of surgical intervention and good outcome was found, possibly attributable to the paucity of details in existing case reports and the difficulty defining the degree of spinal cord compromise from a given lesion. Despite our findings, emergent neurosurgical intervention may be beneficial for the management of complications such as cauda equina syndrome secondary to intrathecal spinal hematoma.
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Affiliation(s)
| | - Tülin Serap Yilmaz
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ekkehard M Kasper
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Yaldizli O, Euler S, Willi B, Wiesbeck GA, Wurst FM. Spontaneous spinal subarachnoid haemorrhage--a complication of alcohol withdrawal therapy. Drug Alcohol Rev 2008; 27:429-32. [PMID: 18584394 DOI: 10.1080/09595230802089735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Non-traumatic spontaneous idiopathic spinal subarachnoid haemorrhage (SSH) is extremely rare. So far, only 12 cases have been described in the literature and there are no data regarding the association between alcohol dependence and SSH. CASE SUMMARY We report the first case of an alcohol-dependent patient with an idiopathic non-traumatic cervical subarachnoid haemorrhage after alcohol withdrawal therapy. CONCLUSIONS Clinicians should be aware of alcohol dependence as an independent risk factor for not only intracranial, but subarachnoid haemorrhage. We recommend performing spinal imaging in alcoholics with sudden onset of severe neck or back pain, even if neurological deficits are absent or coagulation parameters are normal.
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Affiliation(s)
- Ozgür Yaldizli
- Department of Neurology, Kantonsspital St. Gallen, St Gallen, Switzerland.
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Lee ACW, Lau Y, Li CH, Wong YC, Chiang AKS. Intraspinal and intracranial hemorrhage after lumbar puncture. Pediatr Blood Cancer 2007; 48:233-237. [PMID: 16155928 DOI: 10.1002/pbc.20551] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Two cases of spinal epidural hematoma and two cases of intracranial subdural hematoma after lumbar puncture (LP) are reported in children receiving chemotherapy for acute lymphoblastic leukemia and non-Hodgkin lymphoma. The bleeding was asymptomatic but interfered with treatment in one case, and caused either severe backache or headache but no neurological deficit in the other three patients. The platelet counts were 8 and 46 x 10(9)/L in two patients and were normal in the other patients at the time of LP. All recovered without surgical treatment. There is an inherent, albeit uncommon, risk of bleeding into the central nervous system associated with LP in children with cancer and should be distinguished from postdural puncture headache (PDPH). Thrombocytopenia is not always an accompanying factor.
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Affiliation(s)
- Anselm C W Lee
- Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, New Territories, Hong Kong, China.
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Staebler M, Azzi N, Sekhara T, Delpierre I, Damry N, Christophe C. Complications of lumbar puncture in a child treated for leukaemia. Pediatr Radiol 2005; 35:1121-4. [PMID: 15902431 DOI: 10.1007/s00247-005-1509-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2005] [Accepted: 04/21/2005] [Indexed: 10/25/2022]
Abstract
Lumbar puncture may lead to neurological complications. These include intracranial hypotension, cervical epidural haematomas, and cranial and lumbar subdural haematomas. MRI is the modality of choice to diagnose these complications. This report documents MRI findings of such complications in a child treated for leukaemia.
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Affiliation(s)
- Melanie Staebler
- Department of Medical Imaging, Children's University Hospital Queen Fabiola, 15 Avenue JJ Crocq, 1020 Brussels, Belgium
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Gupta SK, Dhir JS, Khosla VK. Traumatic spinal subarachnoid hematoma: report of a case with MRI. SURGICAL NEUROLOGY 1997; 48:189-92. [PMID: 9242247 DOI: 10.1016/s0090-3019(97)00395-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Spinal subarachnoid hematoma (SAH) is uncommon following traumatic injury to the spine. There are few case reports of neurologic deficit secondary to traumatic spinal SAH. CASE DESCRIPTION This 6-year-old boy was injured in a vehicular accident from which he became paraplegic and presented to us 1 week later. Plain X rays were normal and a myelo-computed tomography (CT) scan demonstrated an irregular intradural lesion from D10-L2. The magnetic resonance imaging (MRI) revealed an SAH at D11-12 level, posterior to the cord, which was surgically evacuated. The patient did not improve neurologically. CONCLUSION Significant cord injury and neurologic deficit can occur without obvious abnormalities on plain X rays or CT scan. MRI is very useful in detecting these lesions and can help in their management.
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Affiliation(s)
- S K Gupta
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Sunada I, Akano Y, Kidosaki Y, Shimokawa N, Yamamoto S. Spontaneous spinal subarachnoid hematoma--case report. SURGICAL NEUROLOGY 1995; 44:133-6. [PMID: 7502202 DOI: 10.1016/0090-3019(95)00166-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Spinal subarachnoid hemorrhage is unusual, and rarely results in spinal subarachnoid hematoma because the cerebrospinal fluid tends to dilute the blood and prevent the formation of clots. We describe a patient with spinal subarachnoid hematoma of unusual spontaneous origin. CASE A 66-year-old female presented with sudden onset of intense back pain with paraplegia. Magnetic resonance imaging demonstrated a mass lesion between T2 and T6, compressing the spinal cord anteriorly. Emergency osteoplastic laminotomy exposed a hematoma in the subarachnoid space from T2 to T6, but no source of the hemorrhage was found. The patient was able to walk by herself about 20 days after the operation. CONCLUSION The outcome is significantly influenced by the duration between onset and operation, preoperative neurologic status, and rapidity of symptom progression. Therefore, we emphasize the importance of early diagnosis, and rapid and complete operative removal of spinal subarachnoid hematoma in order to achieve the best outcome.
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Affiliation(s)
- I Sunada
- Department of Neurosurgery, Baba Memorial Hospital, Osaka, Japan
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