Spontaneous spinal epidural hematoma related to amphetamine abuse: A case report.

BACKGROUND: Spontaneous spinal epidural hematoma (SSEH) is a rare condition that is typically associated with hypertension, the use of antithrombotic or sympathomimetic drugs. Here, we report a case of SSEH attributed to the use of amphetamines. CASE DESCRIPTION: A 27-year-old amphetamine user presented with the sudden onset of paraplegia (Frankel A) following amphetamine use. An MRI revealed C7-T2 spinal cord compression due to an epidural hematoma. Following a negative angiogram, the SSEH was removed, and the patient markedly recovered. Notably, by exclusion, the etiology for the SSEH was attributed to the use of amphetamines.
CONCLUSION: Here, we demonstrate the case of a 27-year-old male who presented paraplegic due to an acute C7- T2 SSEH secondary to amphetamine abuse. Copyright:

INTRODUCTION

Spontaneous spinal epidural hematomas (SSEHs) are rare, occurring in approximately 1/1 million individuals/year. Magnetic resonance (MR) studies performed in suddenly myelopathic patients with SSEH will document the location and size of these hemorrhages. Emergent surgical decompression and drainage are typically warranted.[2] SSEHs are usually attributed to hypertension, pregnancy, use of antithrombotics, and cocaine abuse. Here, we present a 27-year-old male whose SSEH was due to the use of amphetamines.[2,5]

CASE PRESENTATION

History

A 27-year-old chronic amphetamine abuser acutely presented with paraplegia just after taking amphetamines. Over a 4 h period, he developed total motor and sensory loss (i.e., Frankel Grade A). The only abnormal laboratory study was the urine toxicology screen that showed the presence of amphetamines. An emergent MRI showed a posterolateral right-sided C2–T6 acute SSEH that caused marked C7–T2 cord compression [Figures 1a and b].

Figure 1:

Initial spinal MRI. Sagittal (a) and axial (b) T2-weighted sequences revealing a right-sided hyperintense posterolateral epidural collection extending from C2 to T6. A significant compression was observed between C7 and T2 (arrow). Signal changes were characteristic of an epidural hematoma.

Surgery

The patient underwent an emergent right-sided C7–T2 hemilaminectomy for hematoma drainage. Neither infection nor tumor was present. The histopathology was consistent with an acute hematoma.

Postoperative MR and clinical course

The day after surgery, an MRI documented near-total drainage of the hematoma [Figures 2a and b]. Further, a repeat angiogram confirmed no vascular malformation. Notably, the patient’s sensorimotor function substantially improved, and within 6 months, he had nearly fully recovered (i.e., sensory intact with residual 4/5 proximal/distal motor lower extremity deficits).

Figure 2:

Postoperative MRI. Sagittal (a) and axial (b) T2-weighted MRI showing near-total drainage of the hematoma and spinal cord decompression.

DISCUSSION

SSEHs typically progress rapidly and often lead to paralysis. Predisposing factors usually include antithrombotic medication, hypertension, and cocaine abuse. We found only one other case of spinal hemorrhage related to amphetamine abuse in the literature. Contrasting the SSEH described in this paper, the case consisted of spinal subdural and subarachnoid hemorrhage after amphetamine use.[3]

Management of SSEH

SSEH requires early surgical spinal cord decompression and drainage to optimize the likelihood of neurological recovery. Further, patients whose SSEH is attributed to amphetamine use typically require strict blood pressure control (i.e., medical management). Those with myelopathy and significant neurological deficits usually require urgent MRI and prompt surgical intervention to achieve the best outcomes.[1,4,6]

Here, the patient presented with a 3-segment cervicothoracic SSEH that was decompressed within 6 h of its onset; the patient’s excellent postoperative neurological recovery was largely attributed to early recognition, diagnosis, and surgical decompression.

CONCLUSION

Here, we presented a 27-year-old male whose abuse of amphetamines resulted in the sudden onset of paraplegia due to an acute MR-documented C2–T6 acute SSEH.