Acute Nontraumatic Spinal Intradural Hematoma in a Patient on Warfarin

Abstract Background Nontraumatic spinal intradural extramedullary hematomas are extremely rare. When they occur, they can rapidly lead to spinal cord or cauda equina compression and have devastating consequences. Objective The aim here was to report a case of this rare phenomenon and discuss the eti...

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Bibliographic Details
Published in:The Journal of emergency medicine 2013-11, Vol.45 (5), p.695-697
Main Authors: Bruce-Brand, Robert A., MCH, MRCSI, Colleran, Gabrielle C., MD, MRCPI, Broderick, James M., MB, BCH, MRCSI, Lui, Darren F., MCH, MRCSI, Smith, Eimear M., MD, FRCPI, Kavanagh, Eoin C., MB, BCH, FRCPI, FFR, RCSI, Poynton, Ashley R., MD, FRCSI
Format: Article
Language:English
Subjects:
Aged
Anticoagulants - adverse effects
Decompression, Surgical
Dura Mater
Emergency
Hematoma - chemically induced
Hematoma - diagnosis
Humans
Male
spinal cord compression
Spinal Cord Diseases - chemically induced
Spinal Cord Diseases - surgery
spinal intradural extramedullary hematoma
spinal subarachnoid hemorrhage
spinal subdural hematoma
Warfarin - adverse effects
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Summary:Abstract Background Nontraumatic spinal intradural extramedullary hematomas are extremely rare. When they occur, they can rapidly lead to spinal cord or cauda equina compression and have devastating consequences. Objective The aim here was to report a case of this rare phenomenon and discuss the etiology, imaging, management, and outcome of intradural hematomas. Case Report We describe the case of a 76-year-old man on warfarin therapy who presented with severe lower back pain and flaccid paraparesis. Blood tests revealed an international normalized ratio of 6.0. A magnetic resonance imaging result suggested an intradural hematoma extending from L1 to L4 and compressing the spinal cord and cauda equina. Emergency surgical decompression revealed an extensive intradural extramedullary hematoma, which was evacuated. The patient showed only minor neurologic improvement 6 months postoperatively. Conclusions Coagulopathy-induced spinal hemorrhage should be included in the differential diagnosis for patients presenting with signs of acute spinal cord compression.
ISSN:0736-4679
2352-5029
DOI:10.1016/j.jemermed.2013.04.048