Spinal subdural haematoma in von Willebrand disease

Franko, Artur; Antulov, Ronald; Dunatov, Siniša; Antončić, Igor; Miletić, Damir

doi:10.2478/v10019-009-0013-0

Abstract

Background. Von Wilebrand disease (vWD) is the most common inherited disorder of hemostasis. Bleeding in patients with von Wilebrand disease is a frequently reported complaint. Patients with inherited bleeding disorders are also in a large number of cases infected with hepatitis C virus (HCV). Studies showed an increased risk factor for intracerebral hemorrhage (ICH) in patients infected with HCV receiving the combination treatment.

Case report. A 44-year old man reported to our Emergency Department with low back pain, headaches, neck pain, leg weakness and urinary retention. The neurological examination showed nuchal rigidity and spastic paraparesis. Thoracic spine MRI revealed a subacute subdural haematoma at T8-T11 level.

Conclusions. To the best of our knowledge, this is the first report of a subdural haematoma of the thoracic spine in a patient with vWD and chronic HCV infection. The presented patient was receiving a combination treatment, a fact that has also to be taken in consideration as a possible risk factor for a bleeding episode.

References

Ewenstein BM. Von Willebrand's disease. Annu Rev Med 1997; 48: 525-42.10.1146/annurev.med.48.1.525
Search in Google Scholar
Rodeghiero F, Castaman G, Dini E. Epidemiological investigation of the prevalence of von Willebrand's disease. Blood 1987; 69: 454-9.10.1182/blood.V69.2.454.454
Search in Google Scholar
Federici AB, Santagostino E, Rumi MG, Russo A, Mancuso ME, Soffredini R, et al. The natural history of hepatitis C virus infection in Italian patients with von Willebrand's disease: a cohort study. Haematologica 2006; 91: 503-8.
Search in Google Scholar
Manns MP, McHutchison JG, Gordon SC, Rustgi VK, Shiffman M, Reindollar R, et al. Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomised trial. Lancet 2001; 358(9286): 958-65.10.1016/S0140-6736(01)06102-5
Search in Google Scholar
Ferencz S, Batey R. Intracerebral haemorrhage and hepatitis C treatment. J Viral Hepat 2003; 10: 401-3.10.1046/j.1365-2893.2003.00441.x12969193
Search in Google Scholar
Nishiofuku M, Tsujimoto T, Matsumura Y, Toyohara M, Yoshiji H, Yamao J, et al. Intracerebral hemorrhage in a patient receiving combination therapy of pegylated interferon alpha-2b and ribavirin for chronic hepatitis C. Intern Med 2006; 45: 483-4.10.2169/internalmedicine.45.168516679707
Search in Google Scholar
Langmayr JJ, Ortler M, Dessl A, Twerdy K, Aichner F, Felber S. Management of spontaneous extramedullary spinal haematomas: results in eight patients after MRI diagnosis and surgical decompression. J Neurol Neurosurg Psychiatry 1995; 59: 442-7.10.1136/jnnp.59.4.4424860857561928
Search in Google Scholar
Domenicucci M, Ramieri A, Ciappetta P, Delfini R. Nontraumatic acute spinal subdural hematoma: report of five cases and review of the literature. J Neurosurg 1999; 91(Suppl 1): 65-73.10.3171/spi.1999.91.1.0065
Search in Google Scholar
Boukobza M, Haddar D, Boissonet M, Merland JJ. Spinal subdural haematoma: a study of three cases. Clin Radiol 2001; 56: 475-80.10.1053/crad.2000.046611428797
Search in Google Scholar
Morandi X, Riffaud L, Chabert E, Brassier G. Acute nontraumatic spinal subdural hematomas in three patients. Spine 2001; 26: E547-51.10.1097/00007632-200112010-0002211725255
Search in Google Scholar
Raffini L, Tsarouhas N. Subgaleal hematoma from hair braiding leads to the diagnosis of von Willebrand disease. Pediatr Emerg Care 2004; 20: 316-8.10.1097/01.pec.0000125661.50937.fc15123904
Search in Google Scholar
Wexler S, Edgar M, Thomas A, Learmonth I, Scott G. Pseudotumour in von Willebrand disease. Haemophilia 2001; 7: 592-4.10.1046/j.1365-2516.2001.00552.x11851759
Search in Google Scholar
Karibe H, Niizuma H, Ohyama H, Shirane R, Yoshimoto T. Hepatitis C virus (HCV) infection as a risk factor for spontaneous intracerebral hemorrhage: hospital based case-control study. J Clin Neurosci 2001; 8: 423-5.10.1054/jocn.2001.081111535009
Search in Google Scholar
Kyriakides AE, Lalam RK, El Masry WS. Acute spontaneous spinal subdural hematoma presenting as paraplegia: a rare case. Spine 2007; 32: E619-622.10.1097/BRS.0b013e318154c61817906565
Search in Google Scholar
Rajer M, Kovač V. Malignant spinal cord compression. Radiol Oncol 2008; 42: 23-31.10.2478/v10019-007-0035-4
Search in Google Scholar
Benito-Leon J, Leon PG, Ferreiro A, Martinez J. Intracranial hypertension syndrome as an unusual form of presentation of spinal subarachnoid haemorrhage and subdural haematoma. Acta Neurochir (Wien) 1997; 139: 261-2.10.1007/BF018447639143596
Search in Google Scholar
Kakazu K, Ohira N, Ojima T, Oshida M, Akiyama M, Horaguchi M, et al. Extensive spinal epidural hemorrhage associated with von Willebrand's disease - a case report. Nippon Seikeigeka Gakkai Zasshi 1980; 54: 501-5.
Search in Google Scholar

Spinal subdural haematoma in von Willebrand disease

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