Skip to main content
Erschienen in: Journal of Thrombosis and Thrombolysis 4/2016

02.02.2016 | Letter to the Editor

Spinal subarachnoid hemorrhage in cortical superficial siderosis after apixaban and clopidogrel therapy

verfasst von: Josef G. Heckmann

Erschienen in: Journal of Thrombosis and Thrombolysis | Ausgabe 4/2016

Einloggen, um Zugang zu erhalten

Excerpt

A 78-year-old man developed back pain without fever and headache. On admission, he showed pronounced positive Lasègue test without focal abnormalities. Due to atrial fibrillation and following coronar stenting he was on medication with apixaban (2, 5 mg bid) and clopidogrel (75 mg daily). Laboratory tests showed slight leukocytosis (11.600/µl) and elevated prostatic specific antigen (8 ng/dl; normal <4.4) due to controlled prostatic cancer. His computed tomography scan of the brain was normal, but magnetic resonance imaging (MRI) with T2* showed cortical superficial siderosis (CSS) (Fig. 1a). The MR angiography was normal. MRI of his spine demonstrated a marked hyperintense fluid level at the height of the second sacral vertebral body (Fig. 1b, c). The lumbar puncture revealed an extensively hemorrhagic cerebrospinal fluid. MRI of the additional spinal axis did not show an identifiable cause, thus a spinal subarachnoid hemorrhage in the context of CSS complicated by new anticoagulant therapy combined with platelet inhibition was diagnosed. A second lumbar puncture 7 days later after cessation of anticoagulant and antithrombotic therapy showed residual xanthochromia of the cerebrospinal fluid. With further conservative therapy the patient recovered within 3 weeks.
Literatur
1.
Zurück zum Zitat Kim YH, Cho KT, Chung CK, Kim HJ (2004) Idiopathic spontaneous spinal subarachnoid hemorrhage. Spinal Cord 42:545–547CrossRefPubMed Kim YH, Cho KT, Chung CK, Kim HJ (2004) Idiopathic spontaneous spinal subarachnoid hemorrhage. Spinal Cord 42:545–547CrossRefPubMed
2.
Zurück zum Zitat Oji Y, Noda K, Tokugawa J, Yamashiro K, Hattori N, Okuma Y (2013) Spontaneous spinal subarachnoid hemorrhage after severe coughing. J Med Case Rep 7:274CrossRefPubMedPubMedCentral Oji Y, Noda K, Tokugawa J, Yamashiro K, Hattori N, Okuma Y (2013) Spontaneous spinal subarachnoid hemorrhage after severe coughing. J Med Case Rep 7:274CrossRefPubMedPubMedCentral
3.
Zurück zum Zitat Cihangiroglu M, Bulut S, Nayak S (2001) Spinal subarachnoid hemorrhage complicating oral anticoagulant therapy. Eur J Radiol 39:176–179CrossRefPubMed Cihangiroglu M, Bulut S, Nayak S (2001) Spinal subarachnoid hemorrhage complicating oral anticoagulant therapy. Eur J Radiol 39:176–179CrossRefPubMed
4.
Zurück zum Zitat Heckmann JG, Möbius C, Lang C, Richter G, Schwab S (2008) Superficial cerebral hemosiderosis. Med Klin (Munich) 103:805–806CrossRef Heckmann JG, Möbius C, Lang C, Richter G, Schwab S (2008) Superficial cerebral hemosiderosis. Med Klin (Munich) 103:805–806CrossRef
5.
Zurück zum Zitat Levy M, Turtzo C, Llinas RH (2007) Superficial siderosis: a case report and review of the literature. Nat Clin Pract Neurol 3:54–58CrossRefPubMed Levy M, Turtzo C, Llinas RH (2007) Superficial siderosis: a case report and review of the literature. Nat Clin Pract Neurol 3:54–58CrossRefPubMed
6.
Zurück zum Zitat Lummel N, Wollenweber FA, Demaerel P, Bochmann K, Malik R, Opherk C, Linn J (2015) Clinical spectrum, underlying etiologies and radiological characteristics of cortical superficial siderosis. J Neurol 262:1455–1462CrossRefPubMed Lummel N, Wollenweber FA, Demaerel P, Bochmann K, Malik R, Opherk C, Linn J (2015) Clinical spectrum, underlying etiologies and radiological characteristics of cortical superficial siderosis. J Neurol 262:1455–1462CrossRefPubMed
7.
Zurück zum Zitat Linn J, Wollenweber FA, Lummel N, Bochmann K, Pfefferkorn T, Gschwendtner A, Brückmann H, Dichgans M, Opherk C (2013) Superficial siderosis is a warning sign for future intracranial hemorrhage. J Neurol 260:176–181CrossRefPubMed Linn J, Wollenweber FA, Lummel N, Bochmann K, Pfefferkorn T, Gschwendtner A, Brückmann H, Dichgans M, Opherk C (2013) Superficial siderosis is a warning sign for future intracranial hemorrhage. J Neurol 260:176–181CrossRefPubMed
8.
Zurück zum Zitat Gattringer T, Eppinger S, Beitzke M, Wuensch G, Niederkorn K, Deutschmann H, Fazekas F, Enzinger C (2015) Cortical superficial siderosis and risk of bleeding after thrombolysis for ischemic stroke. Cerebrovasc Dis 40:191–197CrossRefPubMed Gattringer T, Eppinger S, Beitzke M, Wuensch G, Niederkorn K, Deutschmann H, Fazekas F, Enzinger C (2015) Cortical superficial siderosis and risk of bleeding after thrombolysis for ischemic stroke. Cerebrovasc Dis 40:191–197CrossRefPubMed
9.
Zurück zum Zitat Wollenweber FA, Buerger K, Mueller C, Ertl-Wagner B, Malik R, Dichgans M, Linn J, Opherk C (2014) Prevalence of cortical superficial siderosis in patients with cognitive impairment. J Neurol 261:277–282CrossRefPubMed Wollenweber FA, Buerger K, Mueller C, Ertl-Wagner B, Malik R, Dichgans M, Linn J, Opherk C (2014) Prevalence of cortical superficial siderosis in patients with cognitive impairment. J Neurol 261:277–282CrossRefPubMed
11.
Zurück zum Zitat Jaeger M, Jeanneret B, Schaeren S (2012) Spontaneous spinal epidural haematoma during Factor Xa inhibitor treatment (Rivaroxaban). Eur Spine J 21(Suppl. 4):S433–S435CrossRefPubMed Jaeger M, Jeanneret B, Schaeren S (2012) Spontaneous spinal epidural haematoma during Factor Xa inhibitor treatment (Rivaroxaban). Eur Spine J 21(Suppl. 4):S433–S435CrossRefPubMed
12.
Zurück zum Zitat Kumar N (2012) Beyond superficial siderosis, introducing “duropathies”. Neurology 78:1992–1999CrossRefPubMed Kumar N (2012) Beyond superficial siderosis, introducing “duropathies”. Neurology 78:1992–1999CrossRefPubMed
13.
Zurück zum Zitat Webb AJ, Flossmann E, Armstrong RJ (2015) Superficial siderosis following spontaneous intracranial hypotension. Pract Neurol 15:382–384CrossRefPubMed Webb AJ, Flossmann E, Armstrong RJ (2015) Superficial siderosis following spontaneous intracranial hypotension. Pract Neurol 15:382–384CrossRefPubMed
14.
Zurück zum Zitat Schievink WI, Wasserstein P, Maya MM (2015) Intraspinal hemorrhage in spontaneous intracranial hypotension: link to superficial siderosis? Report of 2 cases. J Neurosurg Spine 20:1–3 Schievink WI, Wasserstein P, Maya MM (2015) Intraspinal hemorrhage in spontaneous intracranial hypotension: link to superficial siderosis? Report of 2 cases. J Neurosurg Spine 20:1–3
Metadaten
Titel
Spinal subarachnoid hemorrhage in cortical superficial siderosis after apixaban and clopidogrel therapy
verfasst von
Josef G. Heckmann
Publikationsdatum
02.02.2016
Verlag
Springer US
Erschienen in
Journal of Thrombosis and Thrombolysis / Ausgabe 4/2016
Print ISSN: 0929-5305
Elektronische ISSN: 1573-742X
DOI
https://doi.org/10.1007/s11239-015-1329-9

Weitere Artikel der Ausgabe 4/2016

Journal of Thrombosis and Thrombolysis 4/2016 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.