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



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.


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.


  1. Bodilsen J, Mariager T, Vestergaard HH, Christiansen MH, Kunwald M, Lüttichau HR, et al. Association of lumbar puncture with spinal hematoma in patients with and without coagulopathy. JAMA. 2020;324:1419–28.

    Article  Google Scholar 

  2. McGill F, Heyderman RS, Michael BD, Defres S, Beeching NJ, Borrow R, et al. The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. J Infect. 2016;72:405–38.

    CAS  Article  Google Scholar 

  3. Wulf H. Epidural anaesthesia and spinal haematoma. Can J Anaesth. 1996;43:1260–71.

    CAS  Article  Google Scholar 

  4. Stoll A, Sanchez M. Epidural hematoma after epidural block: implications for its use in pain management. Surg Neurol. 2002;57:235–40.

    Article  Google Scholar 

  5. Ralley FE. Neuraxial anesthesia is contraindicated in patients undergoing heparinization for surgery. Pro: neuraxial anesthesia should not be used in patients undergoing heparinization for surgery. J Cardiothorac Vasc Anesth. 1996;10:957–60.

    CAS  Article  Google Scholar 

  6. Kreppel D, Antoniadis G, Seeling W. Spinal hematoma: a literature survey with meta-analysis of 613 patients. Neurosurg Rev. 2003;26:1–49.

    CAS  Article  Google Scholar 

  7. Beatty RM, Winston KR. Spontaneous cervical epidural hematoma. A consideration of etiology. J Neurosurg. 1984;61:143–8.

    CAS  Article  Google Scholar 

  8. Miyazaki M, Takasita M, Matsumoto H, Sonoda H, Tsumura H, Torisu T. Spinal epidural hematoma after removal of an epidural catheter: Case report and review of the literature. J Spinal Disord Tech. 2005;18:547–51.

    Article  Google Scholar 

  9. 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–S589.

    Article  Google Scholar 

  10. Kim JY, Lee S, Choi YY, Bae SC. Atypical bone change of spine caused by epidural venous thrombosis in systemic lupus erythematosus with antiphospholipid syndrome. Korean J Intern Med. 2017;32:573–4.

    Article  Google Scholar 

  11. Kirshblum SC, Burns SP, Biering-Sorensen F, Donovan W, Graves DE, Jha A, et al. International standards for neurological classification of spinal cord injury. J Spinal Cord Med. 2011;34:535–46.

    Article  Google Scholar 

  12. Kumar Y, Hayashi D. Role of magnetic resonance imaging in acute spinal trauma: a pictorial review. BMC Musculoskelet Disord. 2016;17:1–11.

    Article  Google Scholar 

  13. Horlocker TT, Vandermeuelen E, Kopp SL, Gogarten W, Leffert LR, Benzon HT. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Fourth Edition). Reg Anesth Pain Med. 2018;43:263–309.

    Article  Google Scholar 

  14. Jayachandran NV, Rajasekhar L, Narsimulu G, Prasad V. Antiphospholipid antibody syndrome presenting with disseminated bleeding and spinal subdural hemorrhage. Spinal Cord. 2007;45:753–5.

    CAS  Article  Google Scholar 

  15. Kim WJ, Hong YK, Yoo WH. Epidural hematoma mimicking transverse myelitis in a patient with primary antiphospholipid syndrome. Rheumatol Int. 2008;28:709–12.

    CAS  Article  Google Scholar 

  16. Zuliani G, Guerra G, Dalla Nora E, Fainardi E. Spinal anterior epidural hematoma in an elderly man with unrecognized lupic anticoagulant taking warfarin. Aging Clin Exp Res. 2011;23:498–500.

    Article  Google Scholar 

  17. Drazin D, Westley Phillips H, Shirzadi A, Drazin N, Schievink W. Neurosurgical management for complicated catastrophic antiphospholipid syndrome. J Clin Neurosci. 2014;21:680–3.

    Article  Google Scholar 

  18. Estcourt LJ, Birchall J, Allard S, Bassey SJ, Hersey P, Kerr JP. et al. British Committee for Standards in Haematology. Guidelines for the use of platelet transfusions. Br J Haematol. 2017;176:365–394.

    Article  Google Scholar 

  19. Liao CC, Hsieh PC, Lin TK, Lin CL, Lo YL, Lee SC. Surgical treatment of spontaneous spinal epidural hematoma: A 5-year experience - Clinical article. J Neurosurg Spine. 2009;11:480–6.

    Article  Google Scholar 

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Author information




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.

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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).

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