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| Year : 1999 | Volume
: 47
| Issue : 2 | Page : 157 |
Spinal epidural haematoma in an haemophiliac with HIV.
Srivatsa A, Lakshminarayanan G
How to cite this article:
Srivatsa A, Lakshminarayanan G. Spinal epidural haematoma in an haemophiliac with HIV. Neurol India 1999;47:157 |
Although intracranial haemorrhage remains among the major causes of death in haemophilics, spinal epidural haematomas are rarely seen. A case of cervical spinal epidural haematoma in a haemophiliac with HIV affliction is described.
A 28 year old haemophilic male patient presented with one month history of fever in the evenings, and associated weight loss. There was no relief with antibiotics for six weeks. Being haemophilic he required blood transfusion every two years. Two days prior to admission, he complained of severe neck pain with radiation to the occipital region. On the day of admission, his pain worsened. He complained of difficulty in moving his hands. The weakness rapidly progressed to quadriparesis, alongwith urinary retention and overflow. His breathing was normal and he didn't complain of any numbness. There was no history of trauma. On examination, he had grade 4/5 quadriparesis and hyperreflexia in all limbs. Sensations were decreased from C5 till C7 bilaterally. The plantars were extensor. There was spinal tenderness. MRI of the cervical spine showed an epidural collection suggestive of acute blood extending from C5 to T1 level, causing cord compression [Figure 1]. With the possibility of an epidural haemorrhage, he was started on steroids and anti haemophilic factor VIII. Over 2 days, his power improved and by the 3rd day, only the hyperreflexia persisted. His bladder function improved. Western Blot test for HIV was positive.
Spinal epidural haematoma though rare,[1] should be definitely kept in mind while treating haemophiliacs as it may be missed. In our patient, with a long history of fever an infectious aetiology was thought of, but surgery was deferred as he was neurologically stable. This might not have been the case if he had deteriorated or had severe neurological deficit at the time of admission. Anti-haemophilic factor replacement therapy seemed a sound treatment measure.[2],[3],[4] Mechanical causes have been reported in upto 40% of cases, but our patient had no such history. Spinal epidural haematomas are rarely seen and have been reported as isolated cases and more in infants. `Substitution' treatment has been reported to show good signs, when instituted immediately.
Patients with haemophilia who develop cord signs should be investigated and treated immediately with replacement therapy. This by itself can prevent the need of surgery. This patient was sent for treatment at the AIDS center and was lost to follow up.
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