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Spinal epidural hematoma in antiphospholipid syndrome: case report and review of the literature

Abstract

Introduction

Spinal epidural hematomas are a surgical emergency, the delay in diagnosis can develop devastating sequelae due to its acute and progressive course. If not treated properly, it may lead to death or permanent neurological deficit. It is a rare condition that can occur in patients with hematologic pathology.

Case presentation

We report a case report and literature review of a patient with antiphospholipid syndrome, who undergoes a diagnostic lumbar puncture for probable fungal meningitis. Developed a spinal acute epidural hematoma with neurological involvement that is evidenced in MRI. Urgent surgical decompression was performed with good results.

Discussion

Despite the low incidence of an epidural hematoma in patients who undergo lumbar puncture, it is important to perform a thorough evaluation in any patient with coagulation abnormalities prior and after a lumbar puncture, by reason of the inherent possibility of developing an epidural hematoma at the site of the procedure. In the same way, early diagnosis and aggressive treatment is necessary in patients who develop progressive neurological symptoms to limit the damage and improve the prognosis for neurological recovery.

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Fig. 1: Brain MRI.
Fig. 2: Lumbar MRI.
Fig. 3: Surgery decompression.

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Authors

Contributions

EGR conceived the case report, acquired data for the review of the literature, and analyzing the data in comparation to the case. JRPM designed the review of the literature, analyzing data, updated reference lists and contributed to writing the report. PMRF contributed to writing the report, and provided feedback to the report. VMPM contributed analyzing data, interpreting results and provided feedback to the report. LASB contributed to writing the report, extracting and analyzing data. CAAO conducted the research and provided feedback to the report. All the authors agreed to all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to José Ramón Padilla-Medina.

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Guerrero-Rodriguez, E., Padilla-Medina, J.R., Reyes-Fernández, P.M. et al. Spinal epidural hematoma in antiphospholipid syndrome: case report and review of the literature. Spinal Cord Ser Cases 8, 11 (2022). https://doi.org/10.1038/s41394-022-00476-z

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