A case of epidural hematoma associated with epidural catheterization which occurred on 12th days after the last medication of ticlopidine hydrochloride

摘要

A 72-year-old woman underwent choledocholithotomy under general anesthesia combined with epidural block. She was complicated with hypertension, diabetes mellitus and angina pectoris, and was given ticlopidine hydrochloride. The medication was stopped 12 days before the operation. Her coagulation tests and platelet counts were within normal ranges. An epidural catheter was inserted at Th 9-10 interspace, and continuous epidural anesthesia was started for postoperative pain. Just after the operation, numbness and motor paralysis in both legs occurred. We stopped continuous epidural anesthesia, and the symptom on right leg improved. However, after 2 days, magnetic resonance imaging revealed epidural hematoma extending from Th7 to L1, and the patient underwent laminectomy. After a month, her motor paralysis in the left leg started to improve gradually. It is possible that the term of discontinuation of ticlopidine was not enough. We should stop antiplatelet drugs early enough, and should be aware of early symptoms of spinal cord compression.