Concomitant Intraspinal and Retroperitoneal Hemorrhage Caused by an Aneurysm on the Celiac Artery: A Case Report

Abstract

Spontaneous spinal hemorrhage is a rare condition. We present a case in which the diagnosis was complicated by a concomitant intra-abdominal hemorrhage. The patient, taking coumarins, presented with acute back pain and abdominal pain and progressive paresis of the lower limbs. Computed tomography angiography of the abdomen showed an intra-abdominal hemorrhage and an aneurysm of the celiac trunk. MR (magnetic resonance) imaging of the spine revealed a combined subdural and epidural hemorrhage from C1 to L1. Both sites were treated conservatively. After 6 months the patient regained strength in both legs with some persistent loss of strength in the left leg. Follow-up MR imaging showed complete resolution of the spinal hemorrhage. The celiac artery aneurysm was treated conservatively. We suggest that the rupture of the celiac artery aneurysm caused increased intra-abdominal pressure leading to spinal hemorrhage. Emergency staff should be aware of the possibility of two rare but concomitant conditions.

Keywords

spinal hemorrhage - coumarins - celiac trunk aneurysm - paresis - abdominal hemorrhage

• References

• 1 Liu Z, Jiao Q, Xu J, Wang X, Li S, You C. Spontaneous spinal epidural hematoma: analysis of 23 cases. Surg Neurol 2008; 69 (3) 253-260 , discussion 260
• 2 Kreppel D, Antoniadis G, Seeling W. Spinal hematoma: a literature survey with meta-analysis of 613 patients. Neurosurg Rev 2003; 26 (1) 1-49
• 3 Taniguchi LU, Pahl FH, Lúcio JE , et al. Complete motor recovery after acute paraparesis caused by spontaneous spinal epidural hematoma: case report. BMC Emerg Med 2011; 11: 10
• 4 Messerer M, Dubourg J, Diabira S, Robert T, Hamlat A. Spinal epidural hematoma: not always an obvious diagnosis. Eur J Emerg Med 2012; 19 (1) 2-8
• 5 Groen RJ. Non-operative treatment of spontaneous spinal epidural hematomas: a review of the literature and a comparison with operative cases. Acta Neurochir (Wien) 2004; 146 (2) 103-110
• 6 Cordova AC, Sumpio BE. Visceral artery aneurysms and pseudoaneurysms – Should they all be managed by endovascular techniques?. Ann Vasc Dis 2013; 6 (4) 687-693
• 7 Pulli R, Dorigo W, Troisi N, Pratesi G, Innocenti AA, Pratesi C. Surgical treatment of visceral artery aneurysms: A 25-year experience. J Vasc Surg 2008; 48 (2) 334-342