Fatal spontaneous spinal subdural hematoma in a patient on anticoagulant therapy.

Shutaro Nagano, Yohsuke Makino, Heather S Jarrell, Nobutaka Arai, Toshitaka Yoshii, Kana Unuma
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Abstract

Spinal subdural hematoma (SSDH) is characterized by sudden onset neck and/or back pain, dysuria, and extremity impairment. The use of anticoagulants is a significant risk factor for SSDH, indicating that early diagnosis is crucial. However, achieving a timely diagnosis can be difficult owing to the rarity of this condition. The first forensic autopsy of a patient who died as the result of a spinal subdural hematoma (SSDH) is presented. A woman in her 70s undergoing anticoagulant therapy was transported to the emergency room with headache, back pain, and lower limb paralysis. The patient was initially diagnosed with spondylolisthesis and subsequently went into cardiac arrest. Her autopsy revealed an SSDH extending from the first thoracic vertebra to the cauda equina, with no associated tumors or vascular abnormalities. A retrospective examination of the patient's imaging and clinical history indicated missed opportunities for early diagnosis. The patient's cause of death was determined to be neurogenic shock due to progressive spontaneous SSDH. This case underscores the importance of early diagnosis and treatment of SSDH, particularly in patients undergoing anticoagulant therapy who are at an increased risk of spontaneous SSDH. Although some studies have suggested that conservative treatment may be effective for cases involving mild symptoms, surgical decompression is generally required for those with rapidly worsening symptoms. SSDH, therefore, should be considered in the differential diagnosis of patients presenting with back pain and neurological deficits, as delays in diagnosis and treatment can significantly affect patient outcomes.

抗凝治疗致死性自发性脊髓硬膜下血肿1例。
脊髓硬膜下血肿(SSDH)的特征是突然发作的颈部和/或背部疼痛,排尿困难和四肢损伤。抗凝剂的使用是SSDH的重要危险因素,提示早期诊断至关重要。然而,由于这种情况的罕见性,实现及时诊断可能是困难的。第一次法医尸检的病人谁死于脊髓硬膜下血肿(SSDH)的结果提出。一位70多岁正在接受抗凝治疗的妇女因头痛、背痛和下肢瘫痪被送往急诊室。患者最初被诊断为脊柱滑脱,随后出现心脏骤停。尸检显示SSDH从第一胸椎延伸至马尾,未见相关肿瘤或血管异常。回顾性检查患者的影像学和临床病史表明错过了早期诊断的机会。患者的死亡原因被确定为进行性自发性SSDH引起的神经源性休克。该病例强调了早期诊断和治疗SSDH的重要性,特别是在接受抗凝治疗的自发性SSDH风险增加的患者中。尽管一些研究表明,对于症状轻微的病例,保守治疗可能有效,但对于症状迅速恶化的患者,通常需要手术减压。因此,在以背痛和神经功能障碍为表现的患者的鉴别诊断中应考虑SSDH,因为诊断和治疗的延误会显著影响患者的预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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