Spinal epidural haematoma is a rare condition, which may be due to trauma, surgery, epidural catheterisation or disorders of coagulation. We report a case of 60 year old lady who was on warfarin for Atrial fibrillation (AF) presented with history of non-traumatic sudden onset pain in both legs and difficulty in walking. Magnetic resonance imaging (MRI) spine demonstrated epidural haematoma which was treated conservatively. Another dilemma was anticoagulation for AF. We examine the options to manage such case.

[download-attachments container="div" style="list" display_icon="1" display_count="1" display__size="0"]

References

1. Yabe H., Ishii A., Niikawa N., et al. An elderly patient who developed spontaneous spinal epidural hematoma during warfarin therapy. Internal Medicine. 2012;51(11):1429-32.
2. Alderman DB. Extradural Spinal-Cord Hematoma. N Engl J Med. 1956 11/01;255(18):839-42
3. Yang N.-R., Kim S.J., Cho Y.J, et al. Spontaneous resolution of nontraumatic acute spinal subdural hematoma. Journal of Korean Neurosurgical Society. 2011;50(3):268-70.
4. Kirazli Y, Akkoc Y, Kanyilmaz S. Spinal epidural hematoma associated with oral anticoagulation therapy. Am J Phys Med Rehabil. 2004;83(3):220-3.
5. Baek BS, Hur JW, Kwon KY, et al. Spontaneous spinal epidural hematoma. Journal of Korean Neurosurgical Society. 2008;44(1):40-2.
6. Groen RJM, Ponssen H. The spontaneous spinal epidural hematoma: A study of the etiology. J Neurol Sci. 1990 9;98(2–3):121-38.
7. Duffilla J, Sparrowa O, Millarb J, et al. Can spontaneous spinal epidural haematoma be managed safely without operation? a report of four cases. 2000;69:816-819
8. Kim T, Lee C, Hyun S, et al. Clinical Outcomes of Spontaneous Spinal Epidural Hematoma: A Comparative Study between Conservative and Surgical Treatment. Journal of Korean Neurosurgical Society. 2012;52(6):523-7.
9. Tawk C., El Hajj MM, Zgheib R., et al. Spontaneous epidural hematoma of the spine associated with oral anticoagulants: 3 Case Studies. International Journal of Surgery Case Reports. 2015;13:8-11.
10. Sagar A., Hassan K. Drug interaction as cause of spontaneously resolving epidural spinal hematoma on warfarin therapy. Journal of Neurosciences in Rural Practice. 2010;1(1):39-42.
11. Khaled M. Kebaish, M.D., F.R.C.S.(C), John N. Awad MD. Spinal Epidural Hematoma Causing Acute Cauda Equina Syndrome.2004;16(6).
12. Jaeger M, Jeanneret B, Schaeren S. Spontaneous spinal epidural haematoma during Factor Xa inhibitor treatment (Rivaroxaban). European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2012;21.
13. Jessica M C, Hayley F A, Efren M, et al. Non-Traumatic Spontaneous Spinal Subdural Hematoma in a Patient with NonValvular Atrial Fibrillation During Treatment with Rivaroxaban. The American Journal of Case Reports.2015;16:377–381.
14. Mazen Z, Samer H, Nishitha T, et al. Rivaroxaban-Induced Nontraumatic Spinal Subdural Hematoma: An Uncommon Yet Life-Threatening Complication. Case Reports in Hematology, vol. 2015, Article ID 275380, 5 pages, 2015.