Hemophilia A in a Senior Patient: A Case Report of Spinal Epidural Hematoma as First Presentation

Abstract

Hemophilia A is a hereditary coagulation disorder. Most cases are diagnosed at birth or at least during childhood. A spontaneous spinal epidural hematoma was developed in a 74-year-old male patient who hadn't had a family or past medical history of bleeding disorders. On magnetic resonance imaging, epidural hematoma at L1-2 was accompanied by spinal stenosis at L4-5 and spondylolytic spondylolisthesis at L5. Hematoma evacuation and surgery for distal lumbar lesions were performed at once. After transient improvement, complete paraplegia was developed due to redevelopment of large epidural hematomas at L1-2 and L4-S1 which blocked epidural canal completely. Emergency evacuation was performed and we got to know that he had a hemophilia A. Factor VIII was 28% of normal value. Mild type hemophilia A could have not been diagnosed until adulthood. Factor VIII should have been replaced before the surgical decompression.

Keywords: Epidural; Hematoma; Hemophilia A; Senior; Spinal; Spontaneous.

Fig. 1. (A) T2 sagittal magnetic resonance imaging which shows a heterogenous large epidural hematoma compressing the cauda equine at the L1-2 segment, (B) a spinal stenosis at L4-5, and (C) a spondylolytic spondylolisthesis.

Fig. 2. T2 sagittal magnetic resonance imaging which shows large epidural hematomas at L1-2 and L4-5 segments. The dura mater was completely compressed by the epidural mass.

Fig. 3. T2 sagittal magnetic resonance imaging which shows the remaining hematomas at L1-2 and L4-5 segments. However, the dura mater was no more compressed.