London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 349 128 Interesting and challenging cases A Rare Case of Spontaneous Spinal Subdural Haematoma that developed after using an elec-tric drill J.J. Cave1, K.M. Sharobeem2 Birmingham University, Birmingham, UNITED KINGDOM1, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UNITED KINGDOM2 Background: Spinal subdural haematomas (SSDH) are rarely encountered in clinical practice; though they require rapid recognition as, through compression of the spinal cord, they can produce serious neurological disability that may not resolve unless treated rapidly. Despite their rarity, the aetiology of SSDH has been discussed in the literature and multiple causes have been reported; mainly haematological dis-orders, underlying neoplasm and arteriovenous malformation. Methods: We report a rare case of spontaneous SSDH that developed in a 65-year-old healthy man who was treated conservatively. We undertook a literature search of all previously reported cases of SSDH. Results: Our patient presented with severe lower back pain that developed suddenly after using a hand held electric drill, and was followed quickly by total paraplegia. MRI of the spine revealed a dorsal sub-dural haematoma at T12. Further investigations including angiographic studies did not demonstrate any underlying cause and since the patient’s neurological signs were improving he was managed conservatively. Within 2 months the patient had shown significant recovery with neuro-rehabilitation and was mobile with the aid of one stick. Conclusion: SSDH are rare and can be caused by multiple pathologies; but this is the first case to be reported af-ter using an electric drill. In all published cases, there has been speculation that a small effort by the patient may have disturbed the intraluminal pressure sufficiently to cause haemorrhage. SSDH often present with severe back pain that can radiate to the lower limbs followed by a neurological deficit. In all cases the investigation of choice is MRI which will accurately identify a spinal haematoma and discern its location. Surgical decompression as a first line management has been advocated, especially in those with a severe deficit or deteriorating neurology. However, conservative manage-ment, as in this case, has also been reported to have a favourable outcome. 129 Interesting and challenging cases Cardiac papillary fibroelastoma - a rare cause of stroke A.F. Santos1, J. Pinho2, V. Ramos3, A. Graça4, J. Pardal5, J. Rocha6, C. Ferreira7 Neurology Department, Hospital de Braga, Braga, PORTUGAL1, Neurology Department, Hos-pital de Braga, Braga, PORTUGAL2, Cardiology Department, Hospital de Braga, Braga, PORTU-GAL3, Cardiothoracic Surgery Department, Hospital de São João, Porto, PORTUGAL4, Pathological Anatomy Department, Hospital de São João, Porto, PORTUGAL5, Neuroradiology Department, Hospital de Braga, Braga, PORTUGAL6, Neurology Department, Hospital de Braga, Braga, POR-TUGAL7 Background: Cardiac papillary fibroelastoma (CPF) is a rare primary cardiac tumor. In spite of its benign nature it has a significant propensity to embolize. We describe one patient in whom emboli originating from CPF caused cerebral infarction; he was submitted to intravenous rtPA and mechan-ical trombectomy. Only two previous reports presented patients with acute ischemic strokes and as-sociated CPF treated with thrombolytic therapy. Case report: A 34-year-old man, smoker, was admitted with right hemiparesis and aphasia of sud-den onset. At neurological examination: mild global aphasia, right homonymous hemianopsia, right central facial palsy, right hemiparesis (NIHSS 13). Brain CT was normal. Thrombolysis with iv tPA was started. At the end of the perfusion his NIHSS score was 10. At 120 minutes after thrombolysis his neurological status deteriorated. An urgent brain CT excluded hemorrhagic transformation, and an endovascular approach was decided with cerebral angiography disclosing a left MCA occlusion. Mechanical clot extraction was performed with partial recanalization of the left MCA peripheral territory. The initial work-up (laboratory studies, ECG, holter, transthoracic echocardiogram) re-vealed no cause for ischemic stroke, so we proceeded with a transesophageal echocardiogram which showed a small mass on the anterior leaflet of the mitral valve. Cardiac surgery was performed. His-tological examination of the removed material was consistent with CPF. Discussion: Ischemic stroke in young patients demands an etiological exhaustive investigation and results many times from uncommon causes. Having detected a cardiac mass and facing the normal-ity of the rest of the investigation, we assumed it as the etiology of the stroke. We think that patients with known CPF should not be excluded from receiving alteplase, but mechanical thrombectomy might represent a safe and effective treatment option.
Karger_ESC London_2013
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