A 63 yr old judge by profession has suden pain while brushing teeth. he is a known case of renal failure with hameodialysis about a month back. MR shows large epidural hematoma in dorsolumbar region with cord edema. After excluding other known causes like, bleeding diathesis, tumour, trauma, it is possibly related to use of anticoagulants in haemodialysis. but can it coccur after one month is debatable. He has also renal ostedystrophy signs on MRI.
The etiological mechanism of spinal epidural haematoma still remains controversial. The spinal epidural venous plexus is postulated commonly to be the origin of the hematoma. Usually, a high intracavitary pressure induced by, for example, pregnancy increases the plexus pressure, and it finally brings about rupture. In these situations, the small spinal artery was reported to be responsible for the bleeding. Abnormal coagulability, atherosclerosis or mechanical compression by a spinal tumor further facilitate vessel rupture.
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