Spinal subdural haematoma: how relevant is the INR?

Abstract

Study design: Case report. Objective: To report a rare cause of spinal cord compression. Setting: University Hospital, Wales, UK. Case report: A 67-year-old gentleman on oral anticoagulation for atrial fibrillation presented with a 4-h history of progressive loss of sensation and weakness in both legs; there was no history of trauma. On examination, he had a flaccid paraplegia with altered sensation in the L1,2,3 dermatomes and complete anaesthesia in the L4,5 distribution. Knee and ankle jerk reflexes were absent, plantars were equivocal and anal sphincter tone was reduced. The patient's international normalized ratio (INR) was 4.1. An MR scan showed an extensive intradural haematoma compressing the cauda equina. The anticoagulation was reversed and an urgent T12-L2 laminectomy was performed; findings were a circumferential haematoma at L1 extending in the anterior canal between T10 and L3. The patient had an uneventful postoperative course generally, but at 1 week there was no neurological recovery. Conclusion: This case highlights that anticoagulation even when well controlled is not without risk. This is particularly of concern as the number of patients receiving long-term anticoagulation therapy has doubled between 1993 and 1998.

Lumbosacral Subdural Hematoma-Case Report-

“…2,5,9,11,14,16,17,22) In many cases, these symptoms are preceded by events such as minor trauma. However, delayed onset was also reported.…”

“…Lumbar SSH usually presents with cauda equina syndrome or lumbago. 2,5,9,11,14,16,17,22) We report a case of lumbosacral subdural hematoma with subarachnoid hemorrhage (SAH) following a dive into the sea, which manifested only as headache at the beginning and caused lumbago a few days later.…”

Subdural spinal haematoma after spinal anaesthesia in a patient taking aspirin

“…It can also be caused by underlying abnormalities, including neoplasms, arteriovenous malformations, arachnoiditis or syringomelia. [5][6][7][8][9] sSDH is an established complication of lumbar puncture 10 and spinal anaesthesia, with the possibility of permanent disability related to these common procedures. Domenicucci et al 3 reviewed 106 published patients with non-traumatic acute sSDH and found that 54% (n = 57) of the patients were affected by deficits of homeostasis.…”

Paraplégie flasque spontanée chez un patient traité par antivitamine K

“…L'héma-tome sous-dural rachidien (HSR), accident majeur [1] et rare des AVK [2][3][4] serait dû à la diffusion d'une hémorragie à partir des espaces sous-arachnoïdiens. L'espace sous-dural n'est qu'un espace virtuel [5] d'où la rapidité d'installation des signes de compression radiculomédullaire.…”