Spontaneous epidural hematoma of spine associated with clopidogrel: A case study and review of the literature

Abstract

Spontaneous spinal epidural hematoma (SSEH) is an uncommon neurological emergency which can present with the features ranging from simple back pain with radiculopathy to complete paraplegia or quadriplegia depending on the site and severity of the compression. Spinal hemorrhage associated with anti-platelet drugs is rarely seen. We report a case of SSEH in a 68-year-old hypertensive male who was on a low dose clopidogrel for secondary stroke prophylaxis and presented with bilateral lower limb paralysis, preceeded by severe back bain. A spinal magnetic resonance imaging scan was performed which revealed a posterior epidural hematoma of the thoraco-lumbar spine. To the best of our knowledge, not more than four cases of clopidogrel related spinal epidural hematoma have been reported. Emergent decompressive laminectomy was done within 4 hours of the presentation with excellent clinical outcome. Clinicians should, therefore, consider the remote risk of SSEH in hypertensive patients who are on anti-platelet drugs as early decompressive laminectomy and evacuation of the hematoma minimizes the permanent neurological damage.

Keywords: Clopidogrel; decompressive laminectomy; hypertension; spontaneous spinal epidural hematoma.

Figure 1

Sagittal T2-weighted images of the spine showing hyper intense signal from T12 to L2 in the posterior spinal epidural space

Figure 2

Axial T2-weighted images showing a posterior spinal epidural hematoma with compression worst at (a) T12 and conus medullaris (b) L1