Good outcomes after the delayed removal of an epidural hematoma: A case report

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Abstract

Rationale:

Epidural hematomas can develop following intrathecal puncture, spinal vascular malformation, or spontaneous hemorrhage. Prompt recognition of symptoms and referral to neurosurgical services are crucial for recovery. We report a rare case of delayed removal of an epidural hematoma that resulted in good patient outcomes.

Patient concerns:

A 69-year-old woman weighing 58 kg presented with back pain that had persisted for 12 years. Her medical history was notable for hypertension. Cervical computed tomography angiography indicated a giant abdominal aortic aneurysm measuring 11.58 × 17.34 × 13.00 cm in her abdominal cavity. Stent graft implantation was scheduled by the interventional therapy group to treat her abdominal aortic aneurysm under single-dose spinal anesthesia. Postoperatively, the patient complained of numbness and swelling of her lower extremities, with progressive paralysis developing in both legs accompanied with sensory disturbances.

Diagnoses:

Delayed magnetic resonance imaging detected an epidural hematoma.

Interventions:

Eighty hours after the onset of sensorimotor symptoms, lumbar decompression and removal of the hematoma were performed via laminectomy under general anesthesia.

Outcomes:

The patient was discharged 2 months after the operation with a 3/5 score on the Muscle Strength Grading System.

Lessons:

Laminectomy may be effective in achieving a good prognosis despite a considerable delay in diagnosis.

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