Spontaneous spinal epidural hematoma associated with thrombolysis and anticoagulation therapy: report of three cases

Three patients with a spontaneous spinal epidural hematoma are presented, o ne of which is exceptional because it could be attributed to thrombolysis w ith alteplase. The other two were correlated with oral anticoagulant therap y. Our second case suggests that Morbus Kahler may be an underlying patholo gy in spinal extradural hematoma. In the third patient neither an obvious ' locus minoris resistentiae' nor a pathological coagulation test could be he ld responsible for the spontaneous bleeding. All three patients underwent l aminectomy and evacuation of the hematoma, Although two of our cases are ex amples of complete recuperation after late operative intervention, early su rgery is preferable. Permanent clinical attention together with a low thres hold to perform magnetic resonance imaging (MRI) leads to a quicker diagnos is of spinal epidural hematoma. We show that administration of gadolinium m ay facilitate correct preoperative localization of the hematoma because the re may be contrast enhancement of the hematoma. Finally, the postoperative policy concerning thromboembolic prophylaxis is discussed. (C) 1998 Elsevie r Science B.V. All rights reserved.