J Korean Med Sci.  2007 Jun;22(3):577-579. 10.3346/jkms.2007.22.3.577.

Clopidogrel-induced Spontaneous Spinal Epidural Hematoma

• Sung JH
• Hong JT
• Son BC
• Lee SW

• KMID: 1778376
• DOI: http://doi.org/10.3346/jkms.2007.22.3.577

Abstract

The hemorrhagic side effects associated with the use of clopidogrel are within the acceptable range and occur mainly at skin or gastrointestinal sites. We report a case of spontaneous spinal epidural hematoma (SSEH) in a 60-yr-old woman who was treated with clopidogrel for frequent transient ischemic attacks. To our knowledge, this is the second reported case of clopidogrel-induced SSEH. The patient's symptoms and past history of clopidogrel use suggested the diagnosis and made the procedure proceed quickly to operate SSEH 9 hr after the onset of paraplegia. The outcome was excellent. Therefore, with the popularity of antiplatelet prescription, physicians should keep in mind and urgently treat this unusual but critical side effect.

Keyword

Antiplatelet Agents; Clopidogrel; Spinal Epidural Hematoma

MeSH Terms

Aged
Brain/pathology
Cerebral Angiography
Female
Hematoma, Epidural, Spinal/*chemically induced
Humans
Ischemia/drug therapy
Magnetic Resonance Imaging
Platelet Aggregation Inhibitors/*adverse effects
Ticlopidine/adverse effects/*analogs & derivatives
Time Factors
Treatment Outcome

Figure

• 

  Fig. 1 Initial brain magnetic resonance (MR) imaging shows small lacunar infarction at the left upper pons (A) and both posterior thalami (B). Brain MR angiography shows no definite extra or intracranial vessel occlusion or stenosis (C).

• 

  Fig. 2 Thoracic sagittal magnetic resonance imaging shows a large elliptical epidural mass that is iso- to hypersignal on T1 (A) and cerebrospinal fluid-like hypersignal on T2-weighted images (B). It is compatible with an acute epidural hematoma with marked cord compression. Postoperative T2-weighted image (C) shows a thoracic laminectomy defect with complete removal of the hematoma and restoration of cord contour.

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