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Vol. 22. Issue 4.
Pages 332-336 (January 2011)
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Vol. 22. Issue 4.
Pages 332-336 (January 2011)
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
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I. Jusué-Torres
Corresponding author
ijusue.hugf@salud.madrid.org

Correspondencia: Servicio de Neurocirugía. Hospital Universitario de Getafe. Carretera de Toledo Km 12500. Getafe 28905 (Madrid) Spain.
, J.M. Ortega-Zufiria, M. Tamarit-Degenhardt, R. Navarro Torres, R. López-Serrano, J. Riqué-Dormido, P. Aragonés-Cabrerizo, J.C. Gómez-Angulo, P. Poveda-Nuñez, P. Jerez-Fernández, J.M. del Pozo-García
Servicio de Neurocirugía. Hospital Universitario de Getafe. Madrid
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Resumen
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 años, 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.

Palabras clave:
Hematoma epidural cervical yatrogénico
Paraplejia
Recuperación espontánea
Tratamiento conservador vs quirúrgico
Abreviaturas:
GE
RM
TSE
Summary
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 showing complete paraplegia and arreflexia 2 hours after analgesic treatment with epidural cervical infiltration for cervicoartrosis. Cervical MRI showed epidural cervical hematoma between C4 and T1 levels. The patient is transferred to our facilities in order to perform surgery. But after showing fast recovery, medical conservative management was elected. After one month, the patient's condition has improved showing no neurological deficits and complete resorption is seen in MRI.

Conclusions

Nowadays, trend is to perform surgery in patients with spinal hematoma and significant neurological deterioration during the first hours. However, good neurological outcomes can be achieved with conservative management, in well selected patients with non progressive, incomplete and partial deficits. Presently, we can not predict wich is the best treatment for each case.

Key words:
Iatrogrenic cervical epidural hematoma
Paraplegia
Spontaneous recovery
Surgery vs conservative management

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