J Korean Neurosurg Soc.  2012 May;51(5):308-311. 10.3340/jkns.2012.51.5.308.

Epidural Hematoma Related with Low-Dose Aspirin : Complete Recovery without Surgical Treatment

• Kim KT
• Cho DC
• Ahn SW
• Kang SH

• KMID: 2066933
• DOI: http://doi.org/10.3340/jkns.2012.51.5.308

Abstract

Hemorrhagic complications associated with aspirin use occur primarily at skin or gastrointestinal sites but can occasionally occur in the central nervous system. In particular, spontaneous spinal epidural hemorrhage (SSEH) associated with aspirin is very rare. We report a case of low-dose (100 mg daily) aspirin-related SSEH that was successfully treated with medical management. Our case indicates that low-dose aspirin could induce SSEH and that conservative treatment with close observation and repeated imaging studies should be considered in cases with neurological improvement or mild deficits.

Keyword

Aspirin; Spinal epidural hematoma; Medical management

MeSH Terms

Aspirin
Central Nervous System
Hematoma
Hematoma, Epidural, Spinal
Skin
Aspirin

Figure

• 

  Fig. 1 Initial and follow-up imaging studies. A : Initial cervical CT shows a high density mass in the dorsal portion of the epidural space from C3 to C5. B : Initial T2 sagittal cervical MRI shows a huge mass in the dorsal portion of the epidural space from C3 to C5 with cord compression. C : Twenty-four hour follow-up CT shows a partial decrease of the hematoma. D : Seven day follow-up MRI (T2 sagittal image) shows complete resolution of the epidural hematoma.

Reference

1. Anderson TJ, Donaldson IM. Spontaneous resolution of cervical spinal epidural haematoma. Postgrad Med J. 1989; 65:488–490. PMID: 2602243.

2. Boukobza M, Guichard JP, Boissonet M, George B, Reizine D, Gelbert F, et al. Spinal epidural haematoma : report of 11 cases and review of the literature. Neuroradiology. 1994; 36:456–459. PMID: 7991091.

3. Brawn LA, Bergval UE, Davies-Jones GA. Spontaneous spinal epidural haematoma with spontaneous resolution. Postgrad Med J. 1986; 62:885–887. PMID: 3809086.

4. Bruyn GW, Bosma NJ. Vin-ken PJ, Bruyn GW, editors. Spinal extradural haematoma. Handbook of Clinical Neurology. 1976. Vol 26. Amsterdam: North-Holland;p. 1–30.

5. Connolly ES Jr, Winfree CJ, McCormick PC. Management of spinal epidural hematoma after tissue plasminogen activator. A case report. Spine (Phila Pa 1976). 1996; 21:1694–1698. PMID: 8839474.

6. Crabbe DC, Mendelow AD, Pharoh P, Large DM, Ions GK. Cervical spinal extradural haematoma causing a transient Brown-Sequard syndrome. J Neurol Neurosurg Psychiatry. 1992; 55:239. PMID: 1564497.

7. Foo D. Spinal epidural hematoma. J Neurosurg. 1996; 84:308. PMID: 8592245.

8. Foo D, Chang YC, Rossier AB. Spontaneous cervical epidural hemorrhage, anterior cord syndrome, and familial vascular malformation. Neurology. 1980; 30:1253–1254. PMID: 7191526.

9. Fukui MB, Swarnkar AS, Williams RL. Acute spontaneous spinal epidural hematomas. AJNR Am J Neuroradiol. 1999; 20:1365–1372. PMID: 10472999.

10. García López A, Pérez Lara JM, Herrainz Hidalgo R, Puente Gonzalo E. Spinal epidural hematoma following thrombolytic therapy for acute myocardial infarction. Orthopedics. 1999; 22:987–988. PMID: 10535565.

11. Groen RJ. Non-operative treatment of spontaneous spinal epidural hematomas : a review of the literature and a comparison with operative cases. Acta Neurochir (Wien). 2004; 146:103–110. PMID: 14963742.

12. Halim TA, Nigam V, Tandon V, Chhabra HS. Spontaneous cervical epidural hematoma : report of a case managed conservatively. Indian J Orthop. 2008; 42:357–359. PMID: 19753167.

13. Harris DJ, Fornasier VL, Livingston KE. Hemangiopericytoma of the spinal canal. Report of three cases. J Neurosurg. 1978; 49:914–920. PMID: 731310.

14. Heye N. Is there a link between acute spinal epidural hematoma and aspirin? Spine (Phila Pa 1976). 1995; 20:1931–1932. PMID: 8560344.

15. Lewis HD Jr, Davis JW, Archibald DG, Steinke WE, Smitherman TC, Doherty JE 3rd, et al. Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina. Results of a Veterans Administration Cooperative Study. N Engl J Med. 1983; 309:396–403. PMID: 6135989.

16. Liao CC, Lee ST, Hsu WC, Chen LR, Lui TN, Lee SC. Experience in the surgical management of spontaneous spinal epidural hematoma. J Neurosurg. 2004; 100:38–45. PMID: 14748572.

17. Liu Z, Jiao Q, Xu J, Wang X, Li S, You C. Spontaneous spinal epidural hematoma : analysis of 23 cases. Surg Neurol. 2008; 69:253–260. discussion 260. PMID: 17900669.

18. Locke GE, Giorgio AJ, Biggers SL Jr, Johnson AP, Salem F. Acute spinal epidural hematoma secondary to aspirin-induced prolonged bleeding. Surg Neurol. 1976; 5:293–296. PMID: 1265647.

19. Mehta SR, Tanguay JF, Eikelboom JW, Jolly SS, Joyner CD, Granger CB, et al. Double-dose versus standard-dose clopidogrel and high-dose versus low-dose aspirin in individuals undergoing percutaneous coronary intervention for acute coronary syndromes (CURRENT-OASIS 7) : a randomised factorial trial. Lancet. 2010; 376:1233–1243. PMID: 20817281.

20. Mishima K, Aritake K, Morita A, Miyagawa N, Segawa H, Sano K. [A case of acute spinal epidural hematoma in a patient with antiplatelet therapy]. No Shinkei Geka. 1989; 17:849–853. PMID: 2797370.

21. Ohm C, Mina A, Howells G, Bair H, Bendick P. Effects of antiplatelet agents on outcomes for elderly patients with traumatic intracranial hemorrhage. J Trauma. 2005; 58:518–522. PMID: 15761345.

22. Park IB, Kim DJ, Kim J, Kim H, Kim H, Min KW, et al. Current status of aspirin user in Korean diabetic patients using Korean health insurance database. J Korean Diabetes Assoc. 2006; 30:363–371.

23. Rois PV, López MR, de Vergara BC, de la LamaZaragoza A, García JG, Uxo JM. Spinal epidural hematoma in hemophilic children : controversies in management. Childs Nerv Syst. 2009; 25:987–991. discussion 993, 995. PMID: 19360421.

24. Schmitz A, Wallny T, Sommer T, Brackmann H, Schulze-Bertelsbeck D, Effenberger W, et al. Spinal epidural haematoma in haemophilia A. Haemophilia. 1998; 4:51–55. PMID: 9873866.

25. Tauber M, Koller H, Moroder P, Hitzl W, Resch H. Secondary intracraroidnial hemorrhage after mild head injury in patients with low-dose acetylsalicylate acid prophylaxis. J Trauma. 2009; 67:521–525. discussion 525. PMID: 19741394.

26. Wagner S, Forsting M, Hacke W. Spontaneous resolution of a large spinal epidural hematoma : case report. Neurosurgery. 1996; 38:816–818. PMID: 8692404.

27. Warner TD, Mitchell JA. Cyclooxygenase-3 (COX-3) : filling in the gaps toward a COX continuum? Proc Natl Acad Sci USA. 2002; 99:13371–13373. PMID: 12374850.

28. Weber J, Hoch A, Kilisek L, Spring A. [Spontaneous intraspinal epidural hematoma secondary to use of platelet aggregation inhibitors]. Dtsch Med Wochenschr. 2001; 126:876–878. PMID: 11569370.