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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A retrospective study was performed of 100 consecutive acute traumatic spinal injury patients with neurological deficit admitted to the Yorkshire regional spinal injuries centre prior to May 1990. Ninety-seven of these patients received prophylactic low dose subcutaneous heparin and 3 patients were excluded because of noted complications. Twenty-six patients developed thromboembolic complications. Apart from the fact that acute spinal cord injury patients are considered to be in an hypercoaguable state, the occurrence of deep vein thrombosis/pulmonary embolism (DVT/PE) in our study, even though these patients were on prophylactic low dose subcutaneous heparin, was related to delay in transfers, operative intervention, level of spinal cord injury and was possibly due to loss of some amount of heparin solution from the prefilled syringe during removal of air bubbles prior to the subcutaneous heparin injection.
Paraplegia 1992 Mar
PMID:Prophylactic low dose heparin anticoagulant therapy in patients with spinal cord injuries: a retrospective study. 163 Aug 42

The authors report 23 cases of heparin-induced thrombocytopenia with vascular complications. The clinical presentation consisted of arterial ischaemia in 16 cases, hemiplegia in 1 case, 4 cases of blue thrombophlebitis, 1 case of bilateral thrombophlebitis, 1 case of pulmonary embolism. The vascular surgeon faced with such emergency complications must be aware of the difficulties of clinical (atypical forms) and laboratory diagnosis (unreliability of platelet aggregability tests). Arterial occlusions are generally accessible to treatment with a Fogarty catheter during an operation performed without the use of heparin. The excessively frequent delay in diagnosis explains the severity of these complications and 2 deaths, 1 case of paraplegia, 4 cases of amputation secondary to arterial occlusion, 4 cases of severe postphlebitis disease, including 2 cases requiring transmetatarsal amputation and one case of pulmonary sequelae after pulmonary embolism were observed in our series of 23 patients. The diagnosis of heparin-induced thrombocytopenia requires immediate discontinuation of heparin therapy. Replacement by low molecular weight heparin is not devoid or risks and can only be considered with a negative platelet aggregability test (in the presence of low molecular weight heparin). As these test can be rarely performed as an emergency procedure, the use of rapid-acting oral anticoagulants appears to be the most reliable solution. The place of platelet antiaggregants and partial interruption of the inferior vena cava is discussed.
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PMID:[Heparin-induced thrombocytopenia. Practical management of vascular complications]. 176 34

This study was concluded on paraplegic and tetraplegic patients of all aetiologies except neoplasic, where paralysis developed within 48 hours. All patients were admitted to the rehabilitation department within 90 days after the onset of paralysis. In a preliminary review of 328 files, there were 27 cases of clinical deep vein thrombosis (DVT) and 10 with pulmonary embolism (PE), 6 of which were fatal. A prospective study was conducted, based on systematic detection of asymptomatic DVT with phlebography. Among the 147 patients, 20 previously presented with DVT. The 127 others underwent phlebography which showed 39 DVT in 29 patients. Eighty seven patients with negative phlebography underwent a second study a month later which showed 14 DVT in 12 patients. Only one minor pulmonary embolism occurred in these 147 patients. The incidence of DVT after acute spinal cord injury and the frequent absence of clinical manifestations were confirmed. Prophylactic anticoagulant therapy is useful but insufficient. This study demonstrates that systematic and repeated detection of DVT by phlebography may reduce the incidence of PE.
Paraplegia 1991 May
PMID:Systematic lower limb phlebography in acute spinal cord injury in 147 patients. 187 Aug 90

A detailed analysis was undertaken to study the incidence of deep vein thrombosis (DVT), pulmonary embolism (PE), and death during the initial hospitalisation after traumatic spinal cord injury (SCI). The National Spinal Cord Injury Statistical Center supplied data on 1419 subjects with acute injuries hospitalised between October 1, 1986 and June 9, 1989. The incidence of PE was 4.6% (4.3% for paraplegia and 4.8% for quadriplegia) and 14.5% for DVT (15.9% for paraplegia and 12.5% for quadriplegia). Fifty two patients (3.7%) died during their initial hospitalisation. Age, gender, and quadriplegia were not statistically significantly correlated with the development of DVT, while motor complete lesion was a better predictor of DVT than a complete lesion. The highest incidence of DVT was 22.9% in patients with motor complete paraplegia, while the lowest incidence was 9.3% in patients with motor incomplete quadriplegia. The only significant predictor for PE was age. Mortality was associated with increased age, PE, quadriplegia, and complete lesions. The highest incidence of death was 14.0% in patients greater than or equal to 40 years of age with quadriplegia and the lowest incidence of death was 0.37% in patients less than 40 years of age with paraplegia. This study emphasises the need for careful analysis and detailed stratification when designing or interpreting SCI research with DVT, PE, and mortality. Completeness of lesion, age, and category of impairment, whether quadriplegia or paraplegia, are appropriate strata to select.
Paraplegia 1991 Jan
PMID:Acute spinal cord injuries and the incidence of clinically occurring thromboembolic disease. 202 73

Two cases of spinal subarachnoid haematoma occurring after spinal anaesthesia are reported. In the first case, lumbar puncture was attempted three times in a 81-year-old man; spinal anaesthesia trial was than abandoned, and the patient given a general anaesthetic. He was given prophylactic calcium heparinate soon after surgery. On the fourth day, the patient became paraparetic. Radioculography revealed a blockage between T10 and L3. Laminectomy was performed to remove the haematoma, but the patient recovered motor activity only very partially. The second case was a 67-year-old man, in whom spinal anaesthesia was easily carried out. He was also given prophylactic calcium heparinate soon after surgery. On the fourth postoperative day, pulmonary embolism was suspected. Heparin treatment was then started. Twelve hours later, lumbar and bilateral buttock pain occurred, which later spread to the neck. On the eighth day, the patient had neck stiffness and two seizures. Emergency laminectomy was carried out, which revealed a subarachnoid haematoma spreading to a level higher than T6 and below L1, with no flow of cerebrospinal fluid, and a non pulsatile spinal cord. Surgery was stopped. The patient died on the following day. Both these cases are similar to those previously reported and point out the role played by anticoagulants. Because early diagnosis of spinal cord compression is difficult, the prognosis is poor, especially in case of paraplegia.
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PMID:[Subarachnoid hematoma and spinal anesthesia]. 227 24

The predictive values of some early post-traumatic clinical symptoms and signs and laboratory tests on the problems, complications and prognosis of the initial treatment of tetraplegic patients were studied. The study was carried out by scrutinizing the files of 54 patients with a cervical spinal cord injury (40 of them complete and 14 incomplete). Most of the patients (n = 43) needed ventilatory support, the duration of which depended on the level and completeness of the spinal cord injury. Bradycardia, hypotonia and tachypnoea at admission occurred most frequently in those patients who later developed complications or died. In addition, the frequency of complications correlated with a patient's age, previous diseases and with the height and degree of the spinal cord injury. Tachypnoea on admission forecast the later development of respiratory complications. All 8 patients who died, 5 of them from pneumonia and 3 from pulmonary embolism, had their spinal cord injury at the level C4 to C5 and they were significantly older than those who survived.
Paraplegia 1989 Feb
PMID:Cervical spinal cord injury: the correlations of initial clinical features and blood gas analyses with early prognosis. 249 25

A 31 years old man who developed paraplegia due to a meningomyelitis is reported. Cerebrospinal fluid examination showed 116 white cells with 57% eosinophils. On the 79th day the patient died from pulmonary embolism. On post mortem examination no eosinophilic infiltrations was found. However, a detailed histologic examination was not performed.
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PMID:[Eosinophilic meningomyelitis. Report of a case]. 666 Nov 4

A 51 year-old female patient, under anticoagulant therapy due to thrombophlebitis and pulmonary embolism, developed sudden paraplegia. Emergency myelogram showed a total block at L2 level and an epidural hematoma was removed at surgery, but the motor deficit remained unchanged post-operatively. The pertinent literature is reviewed, etiological considerations are made and emphasis is placed on early diagnosis and prompt treatment.
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PMID:[Myelopathy induced by anticoagulant medication. Report of a case with spinal epidural hematoma]. 717 38

Pulmonary embolism is a major complication after spinal cord injury and difficult to diagnose in any patient. Supraventricular tachycardia (SVT) is an unusual presentation for pulmonary embolism (PE). This article documents the records of a 60-year-old patient who was undergoing comprehensive rehabilitation after traumatic spinal cord injury and multitrauma. His treatment programme was interrupted by a PE with SVT as the only presenting symptom. This article outlines the clinical approach to the diagnosis of pulmonary embolism. A high index of suspicion of PE should always be kept in mind when SVT occurs in a spinal cord injured patient.
Paraplegia 1995 May
PMID:Supraventricular tachycardia as a presenting sign of pulmonary embolism in paraplegia. Case report and review. 763 Jun 55

Syncope as an initial presentation of pulmonary embolism is unusual. A 16-year-old girl, with T7 paraplegia after a traumatic spinal cord injury, developed syncope on the 33rd hospital day. The episode occurred approximately 3 hours after her first tilting table training and just after her attendant had assisted passive range-of-motion exercise. Subsequent studies showed pulmonary embolism at the left lower branch of the left pulmonary artery, and the branch to lower segment of the lingual lobe. Doctors should be alert to possible diagnosis of pulmonary embolism in such high-risk patients, especially when new onset symptoms or signs appear.
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PMID:Pulmonary embolism presenting as syncope in paraplegia: a case report. 771 41


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