• Josef Finsterer, Stefanie Seywald, Claudia Stöllberger, Walter Krugluger, Robert Tscherney, Andreas Ulram, and Günther Kleinpeter.
• Department of Neurology, Krankenanstalt Rudolfstiftung, Vienna, Austria. fifigs1@yahoo.de
• Neurol. Sci. 2008 Sep 1;29(4):271-3.

ObjectiveSpontaneous spinal epidural hematoma (SEH) has not been reported under anti-thrombotic therapy with acetyl-salicylic acid (ASA) in a dosage of 50 mg/d.MethodsSpinal MRI, emergency laminectomy.ResultsA 77-yo, HIV-negative female under longterm treatment over three years with ASA 50 mg/d for varicositas, prescribed by her general practitioner, experienced sudden onset back pain with radiation towards both knees after getting up in the morning. One-and-a-half hours later she also developed ascending hypesthesia and weakness originating from both distal lower limbs. Three hours after onset, hypesthesia had reached the T10-level bilaterally and she had become paraplegic. There was reduced intestinal motility, stool incontinence, and urinary hesitancy. MRI of the thoraco-lumbar spine demonstrated a SEH T9-L1 indenting the dural sack and compressing the myelon. Immediately after emergency laminectomy T10-12 with micro-surgical evacuation of the clot, 12 h after onset, she could move both legs again and was able to walk with support 7 days after surgery.ConclusionsThis case shows that SEH occurs under a minimal dose of ASA and that such patients rapidly recover upon immediate surgical decompression and evacuation of the hematoma.

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