Author/Editor		Strojnik, Tadej
Title		Netravmatski spinalni hematomi
Translated title		Nontraumatic spinal hematomas
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 67, št. 1
Publication year		1998
Volume		str. 23-7
Language		slo
Abstract		Background. Notraumatic spinal hematomas are rare. Nevertheless we should be aware of this possibility since the delay in operative management may lead to a permanent neurological deficit. The onset of the illness is of sudden occurrence with local pain in the spine followed by radicular spread of pain. Progressive sensory and/or motor deficit may develop within hours or days and coresponds to the level of spinal involvement. Methods. Six patients with nontraumatic spinal hematoma were admitted to the Department of Neurosurgery in the General Hospital Maribor between 1972 and 1997. Five of the hematomas ere situated in the epidural space and one was found in the subdural space. Clinical evaluation consisted of the patients medical history, neurological examination, laboratory investigation and each one underwent the myelography with computer tomography (CT). All patients had subsequent laminectomy. Results. A risk factor for spinal hematoma was idendified in only one of our 6 patients. Myelography revealed a total spinal block in 4 patients and a spinal canal narowing was found in two. A complete lower limb paralysis developed some hours following the onset of local spinal pain in two patients. Both were operated on the same day after 9 and 15 hours respectively. One of them could walk unaided at the time of discharge after two weeks and the other required a course of rehabilitation before she could walk with crutches. The rest of the patients were left with incomplete motor deficit but could walk without help after the oepration. Conclusions:(Abstracts truncated at 2000 characters.)
Summary		Izhodišča. netravmatski spinalni hematomi so redki. Pomembno je zogdnje odkrivanje, da je še možno uspešno zdravljenje. Spinalni hematomi se kažejo z značilno, a nespecifično klinično sliko: (a) nenadna huda lokalna bolečina v hrbtenici, (b) kmalu se bolečina razširi po poteku živčne korenine, (c) v kratkem času (nekaj ur ali dni) se razvijejo nevrološki izpadi različne stopnje. Metode. Prikazujemo šest bolnikov, ki so se zaradi netravmatskega spinalnega hematoma v letih 1972 do 1997 zdravili na našem oddelku. Pri petih bolnikih je bil hematom v epiduralnem prostoru, pri enem pa v subduralnem prostoru. Pri bolnikih smo zabeležili anamnezo, naredili klinični nevrološki pregled, standardne laboratorijske preiskave in radiološke prieskave (RTG slikanje hrbtenice, mielografijo s CT-jem). Bolnike smo zdravili z laminektomijo (9 ur do 28 dni po začetku težav). Rezultati. Dejavnike tveganja smo potrdili le pri enem bolniku. Z mielografijo smo v dveh primerih ugotovili delni blok inv štirih primerih popolni spinalni blok. Dva bolnika sta v nekaj urah po začetku hude bolečine popolnoma ohromela in oba smo operirali isti dan (po 9 oz. 15 urah). Ena bolnica je ob odpustu iz bolnišnice lahko samostojno hodila, druga pa je bila premeščena na Inštitut za rehabilitacijo in po končanem programu pri njih lahko hodi ob berglah. Tudi pri ostalih bolnikih, ki niso popolnoma ohromeli, je bilo operativno zdravljenje uspešno in lahko samostojno hodijo. Zaključki. (Izvleček prekinjen pri 2000 znakih.)
Descriptors		SPINAL CORD COMPRESSION HEMATOMA, EPIDURAL HEMATOMA, SUBDURAL LAMINECTOMY TREATMENT OUTCOME