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Epidural Hematoma with Atypical Presentation

Shroll, Joshua MD, MPH; Guirguis, Maged MD; D’Mello, Ajay MD; Mroz, Thomas MD; Lin, Jia MD, PhD; Farag, Ehab MD

doi: 10.1213/XAA.0000000000000001
Case Reports: Case Report

We present a case of massive spinal epidural hematoma with an atypical presentation characterized by unilateral, isolated motor deficit in the right lower extremity on postoperative day 2 after Collis-Nissen fundoplication and a T7-8 epidural for postoperative pain. The epidural had been placed in the preoperative theater before surgery. Subcutaneous unfractionated heparin was initiated 18 hours later on postoperative day 1 with 3 times daily dosing. The patient also received 3 doses of ketorolac starting 10 hours after epidural placement. Symptoms were first reported on postoperative day 2, 37 hours after epidural placement. Thoracic magnetic resonance imaging showed an epidural hematoma extending from T2 through T12, requiring emergent decompression and evacuation. The patient made a complete recovery without any resultant neurologic deficit.

From the Department of General Anesthesia, Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, Ohio

Accepted for publication September 22, 2013.

The authors declare no conflicts of interest.

Funding: None.

Address correspondence to Ehab Farag, MD, Department of General Anesthesia, Anesthesiology Institute, Cleveland Clinic Foundation, 9500 Euclid Ave., E-31, Cleveland, OH 44195. Address e-mail to FARAGE@ccf.org.

© 2014 International Anesthesia Research Society
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