Spontaneous Spinal Haemorrhage as a Complication of Oral Anticoagulant Therapy: A Case Report and Literature Review

Abstract

Spinal cord haematoma, or haematomyelia, is a rare condition caused by several unusual disease processes. Traumatic events, such as spinal cord injury and surgery or procedures involving the spinal cord, are the most important causes of spinal cord haematoma. Rarely, it is associated with anticoagulation therapy. Irrespective of cause, spinal cord haematoma is considered a neurosurgical emergency and must be treated promptly in order to prevent neurological sequelae. The authors describe the case of a 69-year-old patient taking warfarin in the therapeutic range for a mechanic mitral valve, who developed chest pain with cervical and dorsal radiation, and experienced sudden paraparesis of the limbs. A CT of the spine confirmed haematomyelia. A high index of suspicion, prompt recognition and immediate intervention are essential to prevent major morbidity and mortality from intraspinal haemorrhage.LEARNING POINTSThis article reports an unusual presentation of spontaneous spinal haematoma, imposing the careful elaboration of differential diagnoses, which is very important in internal medicine.The description of this low-incidence case allows the scientific community to assist in approaching patients with similar symptoms.The lack of studies about the etiology and treatment of spontaneous spinal haematoma underlines the need for further studies and research in the area in order to increase the scientific evidence on the approach of these patients.

A Case Report: The Challenging Diagnosis of Spontaneous Cervical Epidural Hematoma

“…SCEH are a dynamic process that often begin with localized neck pain as blood collects in the epidural space, and can progress to paresthesia, paraplegia, quadriplegia, or hemiparesis as the hematoma expands and subsequently compresses the spinal cord. 2,9 This is the same progression we witnessed in our patient. Taha et al described a 41-year-old man diagnosed with SCEH who presented with six days of neck pain radiating to both upper extremities that subsequently progressed to quadriparesis and urinary urgency.…”

“…8 Although various causes have been attributed to SCEH, including the use of antithrombotic medications, in as many as 40-50% of the cases the exact cause remains unknown. 2,9 It is likely that the daily low-dose aspirin played a role in our patient.…”

“…Spontaneous spinal epidural hematomas were first described in the literature in 1869 by Jackson, and have since been reported to have an incidence of 1 per 100,000 people per year and represents 0.3-0.9% of all spinal cord lesions. 1,2 In comparison, traumatic spinal epidural hematomas have been reported to occur in 0.5-1.7% of all spinal injuries. 3 Spinal epidural hematomas occur within the epidural space, similarly to those occurring within the cranium, and cause compression on the vasculature and cord within the spinal canal.…”

Severe Mimic of Transverse Myelitis - Spontaneous Non-Traumatic Intramedullary Hematomyelia: A Case Report

“…Spinal cord hemorrhages are uncommon, with some papers suggesting the incidence is one per 100 000 population annually, representing .3%-.9% of all spinal cord lesions. 1 Intramedullary hematoma, or hematomyelia, is the rarest type of spinal cord hemorrhage, typically presenting with acute back pain, radicular pain, or sudden headache with associated progression of neurologic deficits. 2 Trauma is the most common cause, followed by vascular malformations, malignancy, bleeding disorders, use of anticoagulation, and several rarer etiologies.…”