Background:Spinal intramedullary hemorrhage is a rare event, the disease still has not received enough attention and many characteristics of the disease have not been sufficiently explored. Due to its rarity, it can easily be forgotten or misdiagnosed. Case presentation:We report a case of 72-year-old male patient with a medical history of coronary heart disease, atrial fibrillation (AF), hypertension, cervical spondylosis, carotid and vertebral artery stenosis with low-dose anticoagulation combined with low-dose antiplatelet therapy who suffered from sudden posterior neck and back pain for 3 hours visited our emergency department (ED). The International Normalization Ratio (INR) were controlled well, and other laboratory tests were within normal limits or only slightly abnormal. However, the patient was diagnosed with spinal intramedullary hemorrhage and died finally. Conclusion:Anticoagulation combined with antiplatelet-associated rare and life-threatening complications should be paid more attention.