Spinal subarachnoid and subdural hematoma presenting as a Brown-Séquard-like myelopathy following minor trauma in a patient on dabigatran etexilate

Abstract

Dabigatran etexilate is a relatively new anticoagulant from the class of direct thrombin inhibitors which is administered orally and does not require routine blood work monitoring. Dabigatran may be attractive to both clinicians and patients because of both its convenience and efficacy; however, clinical complications are still being elucidated. Here, we present a previously unreported case of spinal subarachnoid and subdural hematoma presenting as a Brown-Séquard-like myelopathy in a patient after minor trauma in the setting of Dabigatran anticoagulation.

Extensive spontaneous cervical epidural hematoma due to oral anticoagulant (dabigatran) successfully treated with reversal agent idarucizumab alone

“…The presence of aspirin and clopidogrel can potentiate this problem [ Table 1 ]. [ 1 , 2 , 8 , 11 , 12 ] Cases of dabigatran-associated spinal epidural hematoma reported in the literature before the FDA clearance of idarucizumab as a reversal agent in 2015 was treated with surgical intervention. [ 2 , 11 ] Other cases reported successful reduction in hematoma size after the administration of idarucizumab but patients still required surgical decompression and evacuation.…”

“…[ 2 , 11 ] Other cases reported successful reduction in hematoma size after the administration of idarucizumab but patients still required surgical decompression and evacuation. [ 8 , 12 ]…”

“…[2,11] Other cases reported successful reduction in hematoma size after the administration of idarucizumab but patients still required surgical decompression and evacuation. [8,12] CONCLUSION An 86-year-old male on dabigatran and antiplatelet aggregates (i.e., aspirin and clopidogrel) presented with an acute quadriparesis attributed to a spontaneous C2-T2 MR-documented ventral spinal epidural hematoma with marked cord compression. rough the administration of idarucizumab, a dabigatran antagonist, and the cessation of aspirin and clopidogrel, the patient's neurological deficit resolved over a 2-week period, without the need for surgery.…”

Massive Acute Spinal Subdural Hematoma Causing Sudden Onset Paraplegia in a Patient on Anticoagulation

“…The pathophysiology of spontaneous SSDH is still unclear but is theorized to be caused by bleeding within the subdural space itself or as an extension of a subarachnoid bleed into the subdural space after an increase in intrathoracic or intra-abdominal pressure [ 1 , 3 ]. Indeed, there have been cases of concomitant SAH and SSDH [ 7 , 9 , 14 , 18 , 21 ]. Important prognostic factors include neurologic status at presentation, presence of coagulopathy, performance of lumbar puncture, and associated diseases [ 4 ].…”

Acute Spontaneous Spinal Subdural Hematoma: A Case Report

“…Spinal subarachnoid or subdural hemorrhage can present with neurological signs similar to Brown-Séquard syndrome, and it can be caused by trauma [ 9 ], oral anticoagulant use [ 10 ], or thrombocytopenia [ 11 ].…”