FATAL SPONTANEOUS SPINAL EPIDURAL HEMATOMA FOLLOWING THROMBOLYSIS FORMYOCARDIAL-INFARCTION

BACKGROUND This is the first communication of a fatal spontaneous spin al epidural hematoma following thrombolysis. CLINICAL PRESENTATION Spi ne pain may precede neurologic deterioration by many hours;The diagnos is can be accurately made with axial computed tomography (CT) of the i nvolved spinal segment. TREATMENT Emergency surgery is the treatment f or this condition, but conditions such as the acute stage of a myocard ial infarction or intraoperative bleeding difficulties due to iatrogen ic coagulopathy, the degree of preoperative neurologic deficit, and th e timing of surgery must be cautiously considered. CONCLUSIONS Neurosu rgeons will be faced with another devastating complication of thrombol ytic therapy, as long as the available drugs are being used. Early cli nical suspicion and availability of CT or magnetic resonance imaging f or prompt diagnosis are essential to initiate appropriate medical ther apy and timely surgery. New strategies must include the development of completely fibrin-specific thrombolytics and drugs that may rapidly r everse the systemic and local clotting disorder. (C) 1998 by Elsevier Science Inc.