Abstract
Background
Percutaneous coronary intervention and dual antiplatelet therapy are common management for patients with coronary artery disease. Multiple spontaneous intraspinal hematomas mixed with epidural hematoma and subdural hematoma following regular percutaneous coronary intervention is an extremely rare complication. We describe our experiences to treat the elderly who presented with spontaneous spinal epidural hematoma and subdural hematoma in different spinal locations after percutaneous coronary intervention. Neurological examination and magnetic resonance imaging were followed to assess the treatment outcomes for more than 2.5 years.
Case presentation:
In this article, we present a 70 years-old male taking dual antiplatelet therapy for 1 year after drug-eluting stents implantation to right coronary artery and left anterior descending artery for non-ST elevation myocardial infarction had a sudden onset of paraplegia then the autonomic dysfunction immediately after another percutaneous coronary intervention. Whole spinal MRI showed mixed spontaneous spinal subdural hematoma and spinal subdural hematoma, included: anterior C5-T3 acute subdural hemorrhage, right lateral T4 to T8 epidural hemorrhage, and L5-S1 intrathecal hematoma. After urgent cauda equina neurolysis and T7-9 laminectomy to evacuate spinal epidural hemorrhage in accordance with the neurological symptoms, the patient regained walking ability immediately. The urination and defecation function recovered then. The surgical results maintained for at less 2.5 years, even after another percutaneous coronary intervention 1 year later.
Conclusions
Intraspinal hematomas in acute coronary syndromes are scarce but critical conditions after percutaneous coronary intervention. Multiple mixed spontaneous spinal subdural hematoma/ epidural hematoma could be fully reversed by circumspect neurolysis and limited laminectomy timely.
Spontaneous Spinal Epidural Hematoma Developing After Percutaneous Coronary Intervention: Early Diagnosis, Early Intervention and Good Outcome