Spinal epidural hematoma associated with streptokinase treatment for myocardial infarction

Abstract

Study Design: Case Report. Objective: Thrombolytic therapy has become a routine and valuable care for selected patients with acute myocardial infarction ( AMI) and rarely complicates with spinal epidural hemorrhage causing cord compression. Setting: Elazig, Turkey Case report: A 72-year-old woman developed spinal epidural hemorrhage following streptokinase and heparin administration for AMI. Back pain and lower extremity neurologic deficits ensued secondary to spinal cord compression by epidural hematoma. Diagnosis of spinal epidural hematoma, extending through T11 to L2 vertebra levels, could be accurately made by magnetic resonance imaging (MRI). Careful follow-up by neurologic examination, reversal of anticoagulant effects, anti-edema treatment with steroids and a low-intensity rehabilitation program maintained a full recovery. Follow-up MRI, 3 months after the accident, revealed complete resolution of the hematoma. Conclusion: Physicians should be aware of this rare complication secondary to thrombolytic therapy. A high index of suspicion for hemorrhagic complications is necessary, particularly in elderly patients under thrombolytic treatment regardless of spinal pain, and the patient's lethargic or confused status should be taken into account. MRI is a valuable imaging option that gives information on both localization and extent of lesion and recovery.