Heparin induced thrombocytopenia causing acute paraplegia

A 67 year old lady without vascular risk factors underwent prothetic surgery of both knees by means of spinal anaesthesia. On the sixth postoperative day she fell on the floor and revealed a mild weakness of both legs, which worsened to paraplegia two days later. In the MRI of her lower medulla a hyperintense lesion with an uptake of contrast medium was found. The cerebrospinal fluid revealed an inflammatory csf syndrome. The thrombocyte count on admission was about sixty thousand per microlitre. The patient was treated at the intensive care unit and succombed on the fourteenth postoperative day due to an acute pulmonary embolism. As cause of the paraplegia ischemia of the medulla spinalis due to heparin induced thrombocytopenia is discussed, alternatively to possible complication of preceeding spinal anaesthesia or to fibrocartilaginous embolism as a consequence of falling.