Epidural Hematoma in a Patient with Undiagnosed Vitamin K Deficiency: A Case Report

Abstract

A 72 year old man presented for colostomy repair prompting epidural catheter placement for pain management. A prolonged activated partial thromboplastin time (aPTT) coupled with degenerative spine disease were noted prior to placement. Postoperatively, he developed shortness of breath and leg weakness. This impelled a computed tomography (CT) scan for pulmonary embolism (PE) evaluation, which revealed an epidural hematoma. Stable neurologic findings prompted conservative management. In conclusion, 1) prolongation in aPTT should prompt consideration before neuraxial procedures, 2) vitamin K deficiency is a risk factor for epidural hematoma, and 3) hematoma management should be dictated by progression of neurologic findings.