Warfarin-associated Hematomyelia

Abstract

A 71-year-old woman on warfarin (2.5 mg daily) developed severe low back pain with reduced touch sensation and weakness of the lower limbs that progressed to complete paralysis within 28 to 30 hours. Imaging revealed bleeding at the D4 through D11 level, however the patient refused emergency laminectomy. No recovery was observed and the patient was discharged to a rehabilitation facility. Only few other cases of hematomyelia linked to anticoagulant therapy have been reported. Early diagnosis, appropriate management and immediate intervention are needed to prevent irreversible neurological sequelae. The elusive clinical features at presentation may cause an important diagnostic delay.

Anticoagulant Induced Conus Hematomyelia with Subarachnoid Extension.

“…The neurological outcome reported in the literature is bad, with only a few patients showing mild improvement. 3 But our patient has shown dramatic improvement with early reversal of coagulopathy and surgical evacuation. Hence,a high index of suspicion is required in patients on anticoagulation presenting with rapid onset paraparesis/ quadriparesis.…”

“…There are few case reports of anticoagulant induced subdural hematomas but intramedullary hematomas (hematomyelia's) are very rare. 2,4,61,[3][4][5]7,8 Anticoagulant induced intramedullary hematoma in the conus region is very rare and , as per our knowledge, only one case of anticoagulant induced conus hematomyelia has been reported in the literature. www.iosrjournals.org 71 | Page intramedullary hematomas.…”

“…Majority of them presented with localized or radicular pain, rapidly progressive paraplegia/ quadripledia and urinary retention. 3 . Our patient had intramedullary hematoma in the conus region with subarachnoid extension and had presented with severe low back ache, paraparesis and bladder retention.…”

“…4 Anticoagulant induced hematomyelia's are very rare and only one case of anticoagulant induced conus hematomyelia is reported in the literature. 3,7 Here in we report a case of conus hematomyelia with subarachnoid extension who had excellent neurological recovery after surgical evacuation.…”

Spontaneous intramedullary spinal cord haemorrhage due to anticoagulation therapy

“…Patients with haematomyelia suffer from acute sensory deficit and motor weakness caused by spinal cord compression. Laboratory tests often remain within normal limits, and no significant changes in blood count values are noted [7]. However, due to severe clinical manifestation and the deteriorating condition of the patient, MRI was performed.…”