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Hematoma epidural secundario a anestesia espinal: Tratamiento conservador
Bermejo,M.; Casta?ón,E.; Fervienza,P.; Cosío,F.; Carpintero,M.; Díaz-Fernández,M. L.;
Revista de la Sociedad Espa?ola del Dolor , 2004,
Abstract: introduction: epidural hematoma secondary to neuroaxial anesthesia is a rare complication, but highly relevant due to its clinical and medico-legal implications. according to some authors, its incidence can reach 1/190,000-1/200,000 for peridural punctures and 1/320,000 for spinal punctures. early diagnosis and treatment within the first 6-12 hours is the main aspect related to its therapeutic management. however, in some cases such as the one reported here, surgery is not required and the patient can be managed with a conservative treatment. clinical case: a 73-year-old patient, asa iv, with a history of cirrhosis associated to portal hypertension, hypersplenism, copd, obesity, hypertensive cardiopathy and tricuspid failure. he was scheduled for prostate alcoholization after ruling out surgery. preoperative blood analyses showed a prothrombin activity of 80% and 90,000 platelets. several failed attempts of spinal puncture were done, but general anesthesia was finally required with spontaneous ventilation through laryngeal mudpack, propofol, fentanyl and sevoflurane. clinical manifestations appeared after 36 hours, with non-irradiated severe lumbar pain and plantar cutaneous areflexia. the presence of epidural hematoma at the l1-l4 level was confirmed through nmr. given the absence of flaccid paraparesis, sphincter involvement or other sensitive-motor signs and after consultation with the rachis unit and the neurology service, a conservative treatment and an expecting attitude were agreed based on analgesia and strict neurological monitoring, both clinical and radiological. the evolution of the patient was favorable in the next days. discussion: certain clinical conditions can affect the appearance of hematoma after performing a central regional blockade: low molecular weight heparins, difficult punctures, previous vertebral surgery, hepatopathies, drugs, etc. early surgical treatment based on decompression laminectomy is usually required and it is the treatment agr
Hematoma epidural cervical yatrogénico: Presentación de un caso clínico y revisión de la literatura Iatrogenic cervical epidural hematoma: case report and review of the literature  [cached]
I. Jusué-Torres,J.M. Ortega-Zufiria,M. Tamarit-Degenhardt,R. Navarro Torres
Neurocirugía , 2011,
Abstract: Introducción: En la literatura se recogen alrededor de 600 casos de hematomas epidurales espinales. En varios estudios, se afirma que la incidencia de paraparesia secundaria a anestesia epidural oscila entre 0,0005-0,02%. Se han descrito numerosas etiologías, incluyendo cirugía, traumatismos, anticoagulación, malformaciones arteriovenosas, embarazo, procesos hematológicos y punción lumbar. Los procedimientos anestésicos raquídeos y epidurales representan la décima causa más frecuente. Pero en combinación con el tratamiento anticoagulante, dichos procedimientos aumentan su incidencia hasta alcanzar la quinta causa. Publicamos un caso clínico de hematoma epidural cervical yatrogénico en el adulto y el buen resultado obtenido con tratamiento conservador. Caso clínico: Paciente varón de 80 a os, que a las 2 horas de tratamiento analgésico de cervicoartrosis mediante infiltración epidural cervical desarrolla intensa cervicalgia y pérdida de fuerza en extremidades inferiores, mostrando paraplejia completa con arreflexia. En RM cervical se evidencia hematoma epidural entre los niveles C4 y T1. Es trasladado a nuestro centro para cirugía pero ante la rápida recuperación se decide tratamiento médico conservador. Al mes de seguimiento, la situación clínica es similar a la previa, sin secuelas con completa reabsorción del hematoma en RM control. Conclusión: Actualmente, la tendencia general es realizar cirugía en pacientes con hematoma espinal y empeoramiento neurológico importante durante las primeras horas. Sin embargo, se pueden obtener buenos resultados neurológicos con tratamiento conservador, en pacientes bien seleccionados con déficit parcial, incompleto y no progresivo. En el presente, no estamos en condiciones de decir qué tratamiento es el mejor para cada caso concreto. Background: Around 600 spinal epidural hematoma cases have been previously reported. Incidence of paraplegia after epidural anesthesia varies between 0,0005 and 0,02%. Several possible etiologies have been described in the literature, including surgery, trauma, anticoagulant therapy, arteriovenous malformations, pregnancy and lumbar puncture. Spinal and epidural anesthesic procedures represent the tenth most common cause. But in combination with anticoagulant therapy, the forementioned procedures increase its incidence until reaching the fifth most common etiological group. We report the case of an 80 year-old-man with a cervical epidural hematoma who had a good outcome with conservative management. Case report: 80 year-old-man that developed intense cervicalgia with lower limbs weakness
Hematoma espinal Spinal hematoma  [cached]
Antonio Javier García Medina,Grecia María Giniebra Marín,Juan Carlos Bermejo Sánchez
Revista de Ciencias M??dicas de Pinar del R?-o , 2013,
Abstract: El hematoma epidural espinal es un hallazgo poco frecuente en la práctica médica. Se presenta un caso de una paciente portadora en la región dorsal, donde su forma de presentación también se consideró muy inhabitual y confusa; esta debutó con un dolor precordial con irradiación del brazo izquierdo, la espalda y el estómago, instaurándose después una mielitis transversa dorsal. Se presenta el resultado de la resonancia magnética nuclear dorsal, con consideraciones diagnósticas de los diferentes tipos de hematomas espinales. Se realizó una laminectomía desde D3 a D6 y se evacuó un extenso hematoma epidural desde D1 a D8. Epidural spinal hematoma is an infrequent finding in medical practice. A case of a female patient suffering from a pain in the dorsal region, with its way of presentation was also considered as an unusual and confuse occurrence; it started with precordial pain irradiating left arm, back and stomach, establishing a dorsal transverse myelitis. The result of a nuclear magnetic resonance is presented with diagnostic considerations of different types of spinal hematomas. A laminectomy from D3 to D6 was performed and a large epidural hematoma from D1 to D8 was evacuated.
Absceso Espinal Epidural secundario a bloqueo terapéutico: Presentación de un caso
Estorino Escaig,Nereida Rosa; Jiménez,Eligio Vidal; Aneiro Alfonso,Crecencio;
Revista M??dica Electr?3nica , 2010,
Abstract: the epidural spinal abscess is a purulent collection located between the dura mater and the rachimedular duct, being an unusual entity but a devastating situation, and causing a high morbimortality if it is not followed adequately. it is originated by direct extension (contiguity, local invasive procedures) or by dissemination from distant infectious focuses (hematogenic way). it has an incidence of 1 per 10 000 patients, with a bigger incidence in the third age (sixth decade), but without obviating the others, including childhood with literature reports of more than 90 cases; with the advent of drugs used endovenously, there is an increasing tendency in young population, and also a predominance of the male sex. it is low incidence pathology; fever and dorsolumbalgy are the most frequent symptoms, followed by radicular distributed pain, associated to motor deficit and anal and vesical sphincter disturbances. occasionally it can develop a septic picture that reaches even a septic shock. the selected study is the magnetic resonance with gadolinium.
Hematoma epidural secundario al empleo de cabezal autoestático en un adulto Epidural haematoma due to an headrest in an adult  [cached]
R. Serramito-García,A. Arcos-Algaba,J.M. Santín-Amo,F.J. Bandín-Diéguez
Neurocirugía , 2009,
Abstract: El cabezal autoestático es un instrumento utilizado habitualmente en las intervenciones neuroquirúrgicas y a pesar de su utilización adecuada, puede ser el causante de algunas complicaciones graves como la perforación craneal y el desarrollo de hemorragias intracraneales. Presentamos el caso de un paciente varón de 19 a os sometido a una ventriculocisternostomía endoscópica y que presentó un hematoma epidural secundario a la penetración intracraneal de uno de los pinchos del cabezal. A head fixation device with pins is commonly used for immobilization of the patients during neurosurgical procedures. Despite its appropiate management, may be the cause of some serious complications such as skull perforation and intracranial injuries.We report the case of a 19-years-old young admitted for a endoscopic third ventriculostomy who developed an epidural haematoma due to the penetration of the skull by a pin.
Hematoma epidural secundario al empleo de cabezal autoestático en un adulto
Serramito-García,R.; Arcos-Algaba,A.; Santín-Amo,J.M.; Bandín-Diéguez,F.J.; Gelabert-González,M.;
Neurocirugía , 2009, DOI: 10.4321/S1130-14732009000600008
Abstract: a head fixation device with pins is commonly used for immobilization of the patients during neurosurgical procedures. despite its appropiate management, may be the cause of some serious complications such as skull perforation and intracranial injuries.we report the case of a 19-years-old young admitted for a endoscopic third ventriculostomy who developed an epidural haematoma due to the penetration of the skull by a pin.
Absceso Espinal Epidural secundario a bloqueo terapéutico: Presentación de un caso Epidural spinal abscess secondary to therapeutic blockade: Presentation of a case  [cached]
Nereida Rosa Estorino Escaig,Eligio Vidal Jiménez,Crecencio Aneiro Alfonso
Revista M??dica Electr?3nica , 2010,
Abstract: The epidural spinal abscess is a purulent collection located between the dura mater and the rachimedular duct, being an unusual entity but a devastating situation, and causing a high morbimortality if it is not followed adequately. It is originated by direct extension (contiguity, local invasive procedures) or by dissemination from distant infectious focuses (hematogenic way). It has an incidence of 1 per 10 000 patients, with a bigger incidence in the third age (sixth decade), but without obviating the others, including childhood with literature reports of more than 90 cases; with the advent of drugs used endovenously, there is an increasing tendency in young population, and also a predominance of the male sex. It is low incidence pathology; fever and dorsolumbalgy are the most frequent symptoms, followed by radicular distributed pain, associated to motor deficit and anal and vesical sphincter disturbances. Occasionally it can develop a septic picture that reaches even a septic shock. The selected study is the magnetic resonance with gadolinium.
Hematoma epidural espinal espontáneo
Edgar M. G. Fari?a,Renato Lavoyer Escudeiro,Guilherme B. de Aguiar
Medicina (Buenos Aires) , 2012,
Abstract:
Hematoma epidural subagudo Subacute epidural hematoma
Yvei González Orlandi,Luis Elizondo Barrier,Reinel Junco Martín,Jorge Rojas Manresa
Revista Cubana de Cirugía , 2011,
Abstract: Se presenta el caso de un paciente con hematoma epidural subagudo, temporoparietal derecho, secundario a una agresión física. En el cuadro clínico, a las 24 h, predominó la cefalea de intensidad moderada, con somnolencia y agitación psicomotora ligera. Las radiografías simples de cráneo no mostraron alteraciones. Los síntomas se mantuvieron a pesar del tratamiento médico, por lo que se realizó una tomografía axial simple de cráneo que mostró la presencia de un hematoma epidural subagudo temporoparietal derecho, con desplazamiento de estructuras de la línea media. Se realizó una craneotomía temporoparietal derecha para la evacuación del hematoma posterior. El paciente evolucionó satisfactoriamente y se recuperó por completo, tanto clínica como imaginológicamente. This is the case of a patient presenting with right temporoparietal subacute hematoma secondary to a physical act of aggression. In clinical picture at 24 hours there was predominance of headache of moderate intensity with drowsiness and slight psychomotor restlessness. The skull single radiographies didn't show alterations. Symptoms remained despite the medical treatment, thus a single skull axial tomography was carried out showing the presence of a right temporoparietal subacute epidural hematoma with displacement from the middle line structures. A right temporoparietal craniotomy was carried out to evacuation of the posterior hematoma. Patient evolved satisfactorily with a total recovery as much clinical as imaging.
Hematoma epidural subagudo
González Orlandi,Yvei; Elizondo Barrier,Luis; Junco Martín,Reinel; Rojas Manresa,Jorge; Duboy Limonta,Víctor; Pérez Villafuerte,Alberto;
Revista Cubana de Cirug?-a , 2011,
Abstract: this is the case of a patient presenting with right temporoparietal subacute hematoma secondary to a physical act of aggression. in clinical picture at 24 hours there was predominance of headache of moderate intensity with drowsiness and slight psychomotor restlessness. the skull single radiographies didn't show alterations. symptoms remained despite the medical treatment, thus a single skull axial tomography was carried out showing the presence of a right temporoparietal subacute epidural hematoma with displacement from the middle line structures. a right temporoparietal craniotomy was carried out to evacuation of the posterior hematoma. patient evolved satisfactorily with a total recovery as much clinical as imaging.
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