Current recommendations for the prevention of deep venous thrombosis
Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki in Handbook of Venous and Lymphatic Disorders, 2017
For patients in whom spinal hematoma is suspected, diagnostic imaging and definitive surgical therapy must be performed as rapidly as possible in order to avoid permanent paresis. In summary, all patients receiving neuraxial anesthesia and anticoagulant prophylaxis should be monitored carefully and frequently for early signs of cord compression.
Epidural and spinal analgesia
Pamela E Macintyre, Suellen M Walker, David J Rowbotham in Clinical Pain Management, 2008
Technical difficulties with block performance seem to be the single most important risk factor for spinal hematoma.63 Therefore, indications for neuraxial blockade must be weighed carefully and abandoning the procedure should be considered in case of difficulties or “bloody taps.”
A case of spontaneous spinal epidural hematoma mimicking transient ischemic attack
Published in International Journal of Neuroscience, 2022
Cong Liu, Xiuli Liu, Yan Liu, Guomei Ma, Hui Li, Jingzhe Han, Yi Xiang
Spontaneous spinal epidural hematoma (SSEH), a disease with exact etiology unknown, is characterized by acute onset of neck or back pain and rapidly progressive nerve root or spinal cord compression [1]. It is rare in clinical practices, with a prevalence of approximately one in a million [2]. Due to the lack of population-based epidemiological survey data for SSEH, clinicians have a serious lack of understanding of the disease and are prone to miss the best time for treatment, leaving patients with neurological dysfunction which is difficult to recover. In this paper, we report a case of SSEH with rare clinical manifestations, to improve clinicians' understanding of SSEH. The patient was mainly characterized by episodic left lower limb weakness and had been misdiagnosed as TIA.
Influence of clinical experience on accuracy and safety of obliquus capitus inferior dry needling in unembalmed cadavers
Published in Physiotherapy Theory and Practice, 2022
Gary A. Kearns, Troy L. Hooper, Jean-Michel Brismée, Brad Allen, Micah Lierly, Kerry K. Gilbert, Timothy J. Pendergrass, Deborah Edwards
Despite results indicating experience increases accuracy of dry needle placement, experience did not preclude striking the spinal cord with the needle. Descriptive analysis revealed five incidents of the dry needle striking or puncturing the spinal cord (Video 2). One incident occurred with the cranial-medial approach and four occurred with the caudal-medial approach. These results suggest that the cranial-medial approach is safer when compared to the caudal-medial approach, however with both approaches resulting in at least one spinal cord strike, both techniques should be used with caution and risk considered. Regardless of the technique, the needle missed the C2 posterior laminar arch cranially and broached the C1-2 interspinous space in all five incidents. We hypothesized that the caudal-medial approach would be safer than the cranial-medial approach as the caudal angle would take the needle away from the upper cervical spine and toward the lower cervical spine where the interspinous spaces are smaller (Bogduk and Mercer, 2000), yet four of the incidents involving the spinal cord occurred with the caudal-medial approach. Despite the C1-2 interspinous space being larger than the C2-3 interspinous space, a recent case report (Berrigan, Whitehair, and Zorowitz, 2019) described an acute spinal epidural hematoma as a complication following dry needling to the lower cervical spine multifidus musculature suggesting broaching the lower cervical interspinous space is a possibility as well.
Risks and patient outcomes of surgical intervention for hemophilic arthropathy
Published in Expert Review of Hematology, 2019
The level of evidence on hemophilia in the literature is very low. In fact, to date no study on the adverse joint events in hemophilia has been included in the Cochrane Library. Appropriate treatment of hemarthrosis should include prompt diagnosis, adequate hematological management, evacuation of blood in the joint (arthrocentesis), physical medicine and rehabilitation, and prevention of recurrent bleeding. Clinical diagnosis should be confirmed by US. X-rays should also be carried out to discard (or confirm) radiological signs of articular disease. In cases of chronic synovitis, arthroscopic synovectomy should be performed after failure of RS to control the problem. Many people with hemophilia under the age of forty, and even as young as ten, already have severe articular degeneration (advanced joint disease). Currently, the plausible surgical treatments are radial head removal, TEA, THA, arthroscopic debridement of the knee and ankle, TKA, ankle fusion and TAA. In orthopedic surgery for people with hemophilia, general anesthesia is advised, because spinal anesthesia can result in dangerous complications (secondary to a spinal hematoma). The chief benefit of orthopedic surgery in hemophilia is that it notably improves the patient’s quality of life.
Related Knowledge Centers
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