Nonoperative management of spontaneous epidural hematoma in hemophilia A

Authors

  • Ankit Thora Department of Orthopaedics, Shalby Hospital, Ahmedabad, Gujurat, India
  • Nishit Bhatnagar Department Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
  • Anurag Tiwari Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
  • Purushotham Lingaiah Department Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
  • Nitesh Rustagi Department of Orthopaedics, Guru Gobind Singh Government Hospital, New Delhi, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20170034

Keywords:

Hemophilia, Spontaneous epidural hematoma, Nonoperative

Abstract

Background: Spontaneous epidural haematoma is a rare clinical presentation and may be associated with coagulation disorders. These hematomas present usually with rapidly developing paraparesis and any delay in diagnosis may be disastrous.

Methods: We included five patients of spontaneous epidural hematomas in hemophilia A with neurological deficit. They were treated non-operatively with factor VIII replacement therapy with oral tranexamic acid and intravenous dexamethasone as per protocol. All patients were followed up for 6 months and assessed for signs of neurological recovery and radiological resolution of hematoma.

Results: All patients had complete motor recovery within 3 months of initiating treatment and showed resolution of hematoma on MRI.

Conclusions: Prognosis following early initiation of correction of factor deficiency is good.

References

Balkan C, Kavakli K, Karapinar D. Spinal epidural hematoma in a patient with Hemophilia B. Haemophilia. 2006;12:437–40.

Mastronardi L, Carletti S, Frondizi D, Spera C, Maira G. Cervical spontaneous epidural hematoma as a complication of non- Hodgkin's lymphoma. Eur Spine J. 1996;5(4):268–71.

Hayem G, Deutsch E, Roux S, Palazzo E, Grossin M, Meyer O. Spontaneous spinal epidural hematoma with spinal cord compression complicating plasma cell myeloma. Spine. 1998;23:2432–5.

Gurkanlar D, Acikbas C, Cengiz GK, Tuncer R. Lumbar epidural hematoma following lumbar puncture: the role of high dose LMWH and late surgery. A case report. Neurocirugia (Astur). 2007;18:52-5.

Kiehna EN, Waldron PE, Jane JA. Conservative management of an acute spontaneous holocord epidural hemorrhage in a hemophiliac infant. J Neurosurg Pediatr. 2010;6:43–8.

Agrawal D, Mahapatra AK. Spontaneous subdural hematoma in a young adult with hemophilia. Neurol India. 2003;51(1):114–5.

Ziaei JE, Dolatkhah R, Dastgiri S, Mohammadpourasl A, Asvadi I, Mahmoudpour A, et al. Inherited coagulation disorders in the northwestern region of Iran. Haemophilia. 2005;11(4):424–6.

Stanley P, McComb JG. Chronic spinal epidural hematoma in Hemophilia A in a child. Pediatr Radiol. 1983;13(4):241–3.

Rathi N, Rathi A. Haemophilia A presenting as spontaneous spinal epidural haematoma in a 3-month-old infant. BMJ Case Rep. 2010;2010:bcr0520102997.

Borkar SA, Prasad GL, Satyarthee GD, Mahapatra AK. Spontaneous spinal extradural hematoma in a child with hemophilia B, surgery or medical management - A dilemma? J Pediatr Neurosci. 2011;6:131-3.

Sheikh AA, Abildgaard CF. Medical management of extensive spinal epidural hematoma in a child with factor IX deficiency. Pediatr Emerg Care. 1994;10:26-9.

Kubota T, Miyajima Y. Spinal extradural haematoma due to haemophilia A. Arch Dis Child. 2007;92:498.

Falavigna A, Righesso O, Teles AR, Hoesker T. Spontaneous idiopathic spinal epidural hematoma: two different presentations of the same disease. Coluna/Columna. 2010;9(3):338-42.

Lo CC, Chen JY, Lo YK, Lai PH, Lin YT. Spontaneous spinal epidural hematoma: a case report and review of the literatures. Acta Neurol Taiwan. 2012;21(1):31-4.

Fukui MB, Swarnkar AS, Williams RL. Acute spontaneous spinal epidural hematomas. AJNR Am J Neuroradiol. 1999;20(7):1365-72.

Suzer T, Coskun E. Spontaneous spinal epidural hematoma. Turk Neurosurgery. 1997;7:44-7.

Orkin SH, Nathan DG, Ginsburg D, Look AT, Fisher DE, Lux SE. Nathan and Oski’s Hematology of Infancy and Childhood. 5th edition. Philadelphia: Saunders Elsevier; 2009: 1487–1524.

Noth I, Hutter JJ, Meltzer PS, Damiano ML, Carter LP. Spinal epidural hematoma in a hemophilic infant. Am J Pediatr Hematol Oncol. 1993;15:131-4.

Meena AK, Jayalakshmi S, Prasad VS, Murthy JM. Spinal epidural haematoma in a patient with haemophilia-B. Spinal Cord. 1998;36:658–60.

Sheikh RA, Javaid M, Butt K, Sohail MT. Spontaneous extradural hematoma of cervical spine in patients with haemophilia. Rawal Medical J. 2012;37:203-5.

Ahn DK, Jung WS, Lee JI. Hemophilia A in a senior patient: a case report of spinal epidural hematoma as first presentation. Asian Spine J. 2015;9:452-5.

Downloads

Published

2017-02-22

Issue

Section

Original Research Articles