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

  • Ana Patricia Castanheira Gomes Internal Medicine Department, Centro Hospitalar Cova da Beira, EPE, Covilhã, Portugal
  • Eduardo Cernadas Internal Medicine Department, Centro Hospitalar Cova da Beira, EPE, Covilhã, Portugal
  • Juliana Sá Internal Medicine Department, Centro Hospitalar Cova da Beira, EPE, Covilhã, Portugal
  • Helena Brito Emergency Department, Centro Hospitalar Cova da Beira, Covilhã, Portugal
  • Ricardo Costa Emergency Department, Centro Hospitalar Cova da Beira, Covilhã, Portugal

Keywords

Hematomyelia, warfarin, laminectomy, epidural hematoma, spinal hematoma, spinal cord compression, myelopathy, spinal cord disease, neurologic defect

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.

References

  • Lo CC, Chen JY, Lo YK, Lai PH, Lin YT. Spontaneous spinal epidural hematoma: a case report and review of the literatures. Acta Neurol Taiwan 2012;21:31–34.

  • Paiva WS, Amorim RL, Rusafa E, Taricco MA, Bor-Seng-Shu E, Figueiredo EG. [Idiopathic spinal epidural hematoma in patients with sudden paraplegia: a case report]. Rev Neurol 2008;46:540–542.

  • Baek BS, Hur JW, Kwon KY, Lee HK. Spontaneous spinal epidural hematoma. J Korean Neurosurg Soc 2008;44:40–42.

  • Gundag M, Hakan M, Dogan K, Kitis S, Ozkan N. Spontaneous resolution of paraparesis because of acute spontaneous thoracolumbar epidural hematoma. Iran Red Crescent Med J 2012;14:574–577.

  • Kim KT, Cho DC, Ahn SW, Kang SH. Epidural hematoma related with low-dose aspirin: complete recovery without surgical treatment. J Korean Neurosurg Soc 2012;51:308–311.

  • Yang SM, Kang SH, Kim KT, Park SW, Lee WS. Spontaneous spinal epidural hematomas associated with acute myocardial infarction treatment. Korean Circ J 2011;41:759–762.

  • Nakanishi K, Nakano N, Uchiyama T, Kato A. Hemiparesis caused by cervical spontaneous spinal epidural hematoma: a report of 3 cases. Adv Orthop 2011;2011:516382.

  • Gopalkrishnan CV, Dhakoji A, Nair S. Spontaneous cervical epidural hematoma of idiopathic etiology: case report and review of literature. J Spinal Cord Med 2012;35:113–117.

  • Munõz G, Cuello J, Rodriguez M, Iglesias Mohedano I, Dominguez Rubio R. Hematoma espinal epidural espontaneo: estudio retrospectivo de una serie de 13 casos. Neurología 2015;30:393–400.

  • Jackson R. A case of spinal apoplexy. Lancet 1869;94(2392):5–6.

  • Bain N. A case of haematorrachis. Br Med J 1897;2(1912):455.

  • Bruyn GW, Bosma NJ. Handbook of clinical neurology. Amsterdam: North Holland Publishing; 1976.

  • Beatty RM, Winston KR. Spontaneous cervical epidural hematoma. J Neurosurg 1984;61:143–148.

  • Varela Rois P, González García J, Regueira Portas M, Martínez Cueto P, Azevedo González E. Hematomas espinales: la apoplejía espinal. Neurología 2010;25:96–103.

  • Al-Mutair A, Bednar DA. Spinal epidural hematoma. J Am Acad Orthop Surg 2010;18:494–502.

  • Bhat KJ, Kapoor S, Watali YZ, et al. Spontaneous epidural hematoma of spine associated with clopidogrel: a case study and review of the literature. Asian J Neurosurg 2015;10:54.

  • Bakker NA, Veeger NJ, Vergeer RA, et al. Prognosis after spinal cord and cauda compression in spontaneous spinal epidural hematomas. Neurology 2015;84:1894–1903.

  • Dziedzic T, Kunert P, Krych P, et al. Management and neurological outcome of spontaneous spinal epidural hematoma. J Clin Neurosci 2015;22:726–729.

  • Kokubo R, Kim K, Sugawara A, Nomura R, Morimoto D, Isu T, et al. Treatment of spontaneous spinal epidural hematoma. No Shinkei Geka 2011;39:947–952.

  • Zhong W, Chen H, You C, et al. Spontaneous spinal epidural hematoma. J Clin Neurosci 2011;18:1490–1494.

  • Torres A, Acebes JJ, Cabiol J, Gabarros A, López L, Plans G, et al. Revisión de 22 casos de hematomas epidurales espinales. Factores pronósticos y manejo terapéutico. Neurocirugía (Astur) 2004;15:353–359.

  • Park J, Lee JB, Park JY, Lim DJ, Kim SD, Chung YK. Spinal cord infarction after decompressive laminectomy for spontaneous spinal epidural hematoma–case report. Neurol Med Chir (Tokyo) 2007;47:325–327.

  • Ko JI, Kim T, Jwa CS, Jang JY, Jeong KY, Suh GJ, et al. Spontaneous spinal epidural hematoma presenting as Brown-Sequard syndrome. Am J Emerg Med 2013;31:e3–4.

  • Dimou J, Jithoo R, Morokoff A. Spontaneous spinal epidural haematoma in a geriatric patient on aspirin. J Clin Neurosci 2010;17:142–144.

  • Haussmann O, Kirsch E, Radu E, Mindermann Th, Gratzl O. Coagulopathy induced spinal intradural extramedullary haematoma: report of three cases and review of the literature. Acta Neurochir (Wien) 2001;143:135–140.

  • Morandi X, Laurent R, Emmanuel C, et al. Acute nontraumatic spinal subdural haematoma in three patients. Spine 2001;26:547–551.

  • Yabe H, Ishii A, Niikawa N, Matsubayashi H, Kakei M, Kawakami M, et al. An elderly patient who developed spontaneous spinal epidural hematoma during warfarin therapy. Intern Med 2012;51:1429–1432.

  • Babayev R, Ekşi MŞ. Spontaneous thoracic epidural hematoma: a case report and literature review. Childs Nerv Syst 2016;32:181–187.

  • Tawk C, El Hajj Moussa M, Zgheib R, et al. Spontaneous epidural hematoma of the spine associated with oral anticoagulants: 3 case studies. Int J Surg Case Rep 2015;13:8–11.

  • Iwatsuki K, Deguchi M, Hirata H, et al. Spontaneously resolved recurrent cervical epidural hematoma in a 37-week primigravida. Global Spine J 2015;5:e44–47.

  • Yamao Y, Takagi Y, Kawauchi T, et al. Surgical management of recurrent spontaneous spinal epidural hematoma with 3 episodes. Spine (Phila Pa 1976) 2015;40:E996–998.
  • Published: 2018-12-12

    Issue: Vol 5 No 12 (view)

    Section: Articles

    How to cite:
    Gomes, A. P., Cernadas, E., Sá, J., Brito, H., & Costa, R. (2018). Spontaneous Spinal Haemorrhage as a Complication of Oral Anticoagulant Therapy: A Case Report and Literature Review. European Journal of Case Reports in Internal Medicine, 5(12). https://doi.org/https://doi.org/10.12890/2018_000887