Spontaneous Epidural Hematoma Of Spine In A Patient On Clopidogrel - A Case Report & Review Of Literature

Abstract

Spontaneous spinal epidural hematoma is a rare clinical entity. Epidural hematoma without trauma or other mechanical insult are defined as spontaneous spinal epidural hematoma. These patients present with simple to severe acute onset back pain with radiation to the limbs (radiculopathy), or with neurological deficit ranging from paraplegia to quadriplegia. Here we report a case of spontaneous spinal epidural hematoma (SSEH) in a middle aged lady, who is post hysterectomy for carcinoma cervix and post renal transplant, on Clopidogrel for last 15 years for a previous transient ischemic attack (TIA). She had severe acute onset back pain while she was sleeping at night along with radicular pain down her lower limbs. She was evaluated with MRI of the spine which showed epidural hematoma from D11-L2 region. She did not have any neurological deficit. She was managed conservatively and clopidogrel was withheld with excellent clinical outcome. Physicians should bear in mind the possibility of spontaneous spinal epidural hematoma when patients are put on long term anti-platelets for cerebrovascular accidents.