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Fırat Üniversitesi Sağlık Bilimleri Tıp Dergisi
2016, Cilt 30, Sayı 3, Sayfa(lar) 107-111
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Spontaneous Spinal Epidural Hematomas: Evaluation of 12 Cases
Bekir AKGÜN, Mehmet Beşir SÜRME, Sait ÖZTÜRK, Fatih Serhat EROL
Fırat Üniversitesi, Tıp Fakültesi, Beyin Cerrahi Anabilim Dalı, Elazığ, TÜRKİYE
Keywords: Antiaggregant drugs, anticoagulant drugs, surgical treatment, magnetic resonance imaging, spontaneous spinal epidural hematoma

Objective: Spontaneous spinal epidural hematomas (SSEH) are rare type of bleeding which require urgent, neurosurgical intervention. We evaluated our patient series, management and discussed them in the light of the literature.

Material and Methods: We retrospectively reviewed 12 SSEH patients who were operated between January 2011 and December 2016. Patients' genders, ages, time of admission after symptoms developed, comorbidities, antiaggregant/anticoagulant drug use, bleeding levels, neurological examination at admission, discharge and at the 3rd month were assessed according to ASIA (American Spinal Injury Association) score.

Results: 8 of the patients were female, 4 were male. They were between 31 and 78 years old. Medication history was as follows: 5 patients coumadin, 4 patients aspirin and 1 patient had a story of clexane usage. Hypertension was present in 2 cases. 6 of the patients who were able to be operated within the first 24 hours after the onset of the symptoms, were found to have improved ASIA scores in early and late postoperative period. Significant improvements couldn’t be obtained in early period in 5 of 6 patients who were operated between 24-48 hours. Mild improvement was observed in the 3rd month follow-ups. Mortality was seen in 1 patient.

Conclusion: The most important risk factors for SSEH are anticoagulant and antiaggregant use. MRI is valuable for detection. CT may also be used, when MRI can’t be achieved. The time between the onset of symptoms and surgery, and the preoperative neurological status are affecting the prognosis. Physical Therapy has an important role in recovery after surgery. Multilevel, wide laminectomies can cause instability, so partial and hemilaminectomies or laminotomies may be preferred.

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