An Elderly Patient who Developed Spontaneous Spinal Epidural Hematoma during Warfarin Therapy

Abstract

Spontaneous spinal epidural hematoma (SSEH) is an uncommon but clinically important disease, and delayed diagnosis of this condition can have severe consequences. General physicians should consider the possibility of SSEH when they encounter a patient with a sudden onset of unexplained cervical or back pain or subsequent radicular symptoms during anticoagulant therapy. Immediate magnetic resonance imaging is essential for early diagnosis. In this article, we present a rare case of an 80-year-old man who developed cervical SSEH during warfarin therapy.

Spontaneous spinal epidural haematoma: A retrospective study of a series of 13 cases

“…3,5,9 In most published cases, however, no arterial ruptures can be observed at the time of surgery, whereas patients do show epidural venous bleeding. 14,22,25 Patients not treated with OACs or antiplatelet drugs, and those with an INR < 3, had a better long-term prognosis. 3,4 SSEH is most frequently reported in patients between the ages of 40 and 80.…”

“…3,4,7,8,11,12,15,16,[19][20][21][22]26,33 Performing a spinal column CT is a valid alternative for health centres lacking an MRI scanner. 3,4,7,8,11,12,15,16,[19][20][21][22]26,33 Performing a spinal column CT is a valid alternative for health centres lacking an MRI scanner.…”

“…4,7,8,19,20,22 In patients with marked motor impairment, surgery is not recommended more than 36 hours after symptom onset. 1,4,7,8,22 Exceptionally, complete recovery has been reported in patients undergoing surgery 96 hours after symptom onset. 6 The literature shows that increasing numbers of patients are treated conservatively (corticosteroids or symptomatic treatment).…”

“…[1][2][3][4] Haematoma is considered to be spontaneous when no causes can be directly associated with its onset, as occurs in 40% to 50% of cases. 3,4,[6][7][8][11][12][13]15,17,19,20,[22][23][24] Early clinical diagnosis and confirmation with an imaging study (preferably an MRI scan) are of vital importance. 1-18 Its estimated incidence rate is 1 new case per million population per year, accounting for 0.3% to 0.9% of all space-occupying spinal cord lesions.…”

Spinal subarachnoid and subdural hematoma presenting as a Brown-Séquard-like myelopathy following minor trauma in a patient on dabigatran etexilate

“…The development of spontaneous spinal epidural hematoma secondary to warfarin use, the oldest anticoagulant used in clinical practice, is well known [1], [2], [3]. In the setting of spontaneous spinal epidural hematoma, however, only one case report identifies warfarin administration leading to an episode of Brown-Séquard syndrome (BSS) [4].…”