A Rare Case Presentation of Apixaban-induced Nontraumatic Spinal Subdural Hematoma

Abstract

A spinal subdural hematoma is a rare clinical entity and an uncommon urgent complication that can be associated with the use of vitamin K and less commonly nonvitamin K oral anticoagulants. It is considered a neurological emergency requiring prompt diagnosis and surgical intervention in the majority of the cases. Herein, we present an 84-year-old male patient with a history of nonvalvular atrial fibrillation on apixaban who presented with complaints of bilateral lower extremity weakness, severe back pain, and urinary retention. His lumbar and thoracic spine images showed a diffuse spinal subdural hematoma. Urgent neurosurgical intervention was performed with minimal improvement in his symptoms postoperatively. We report a case of spontaneous spinal subdural hematoma related to apixaban use with relevant literature review.

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“…SSDH is a rare, uncommon condition characterized by a sudden onset of headache, back pain, or radicular pain and has rapid progression of spinal cord compression symptoms such as sensorimotor change, autonomous function, and neurogenic bladder . [ 3 , 8 , 11 , 12 , 16 , 19 , 20 ] Early diagnosis of SSDH is essential, because the compression can compromise the spinal cord and/or roots of the cauda equina, resulting in permanent neurologic deficit or death. [ 6 , 20 ] SSDH usually presents in between 45 and 60 years of life, with a slight female predominance, predominantly in the thoracic spine, followed by the cervicothoracic and thoracolumbar spine.…”