Acute Nontraumatic Spinal Subdural Hematoma

Warfarin是一種預防血栓的抗凝血劑，其造成的副作用包括有出血、組織壞死、骨質疏鬆及Purple toe syndrome。在這些副作用之中，出血為最主要且最致命的。Warfarin造成的脊椎急性硬腦膜下出血在臨床上是極為少見的病例，而且可能危及生命。因此，在此提出一脊椎急性硬腦膜下出血之病患，臨床表現為下背痛後快速進展至下肢癱瘓及排便和解尿功能異常。在給予維他命K1及新鮮冷凍血漿矯正凝血異常後，此病患接受了緊急手術來移除血塊及減壓，並接受了第二次手術來移除再發的脊椎硬腦膜下出血。最後，在適當的復健之後，病患的神經學功能逐漸恢復。本文亦討論有關抗凝血劑過量(warfarin)，在此情況下之處置與治療，及脊椎急性硬腦膜下出血相關之臨床表現、診斷方式、治療及預後。

關鍵字

脊椎急性硬腦膜下出血；下肢癱瘓； cauda equina syndrome ； warfarin

並列摘要

The complications of warfarin therapy include hemorrhage, warfarin-related tissue necrosis, osteoporosis and purple toe syndrome. Hemorrhage remains the major and fatal complication of warfarin. Warfarin-related acutely spinal subdural hematoma is extremely rare but a potentially life-threatening disorder. Herein, we present a patient with warfarin-related spinal subdural hematoma who experienced back pain and progressive paraplegia, as well as bowel and urinary dysfunction. Emergency surgical intervention was performed after administration of a vitamin K1 injection and supplementation with frozen fresh plasma. Due to a lack of improvement in the patient's neurological functioning, the MRI investigation was repeated a second time and a further surgical intervention carried out to eliminate recurrent hematoma formation. Following an adequate rehabilitation program, this patient has gradually recovered neurological functioning. We also discussed the management of warfarin overdose with such a condition.

並列關鍵字

spinal subdural hematoma ； paraplegia ； cauda equina syndrome ； warfarin

國際替代計量

Acute Nontraumatic Spinal Subdural Hematoma

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