Spontaneous Spinal Epidural Hematoma due to Anticoagulant Therapy: A Case Report and Literature Review
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Department of Orthopaedics, Hospital Sarikei, Jalan Rentap, 96100 Sarikei, Sarawak, MALAYSIA
Associate Prof / Consultant Rehab Medicine Physician Rehab Medicine Unit, Department of Orthopaedic and Traumatology, Faculty of Medicine, University Kebangsaan, MALAYSIA
Associate Prof Dr / Radiologist Radiology Unit Department of Radiology Faculty of Medicine University Kebangsaan, MALAYSIA
House Officer, Hospital Sungai Buloh, MALAYSIA
Professor / Consultant Rehab Medicine Physician Rehabilitation Unit, Department of Orthopaedic and Traumatology Faculty of Medicine Universiti Kebangsaan MALAYSIA
Online publication date: 2020-03-06
Publication date: 2020-03-06
Electron J Gen Med 2020;17(3):em197
We report a case of spontaneous spinal epidural hematoma (SSEH) that occurred in a patient on life-long warfarin following liver transplant due to decompensated liver failure secondary to primary Budd-Chiari syndrome.

Patients and Methods:
Our patient presented with acute central back pain with bilateral lower limb paralysis and incontinence with neurological level of T8 American Spinal Injury Association Impairment Scale (AIS) A. There were no history of fever, trauma or straining. MRI revealed a hyper-intense lesion at level of T8 till T10 and patient underwent an urgent laminectomy which revealed an epidural hematoma at that level.

Post-operatively, patient gradually improved with final neurology level at level of T9 AIS D prior to discharge.

A prompt diagnosis and intervention are needed in cases of SSEH to achieve a favourable outcome.

Bakker NA, Veeger NJGM, Vergeer RA, Groen RJM. Prognosis after Spinal Cord and Cauda Compression in Spontaneous Spinal Epidural Hematomas. Neurology 2015;84:1894-903. PMid:25862799.
Raasck K, Habis AA, Aoude A, Simões L, Barros F, Reindl R, Jarzem P. Spontaneous Spinal Epidural Hematoma Management: A Case Series and Literature Review. Spinal Cord Ser Cases 2017;16043. PMid:28382214 PMCid:PMC5289268.
Kreppel D, Antoniadis G. Seeling W. Spinal Hematoma: A Literature Survey with Meta-analysis of 613 Patients. Neurosurg Rev 2003;26(1):1-49. PMid:12520314.
Groen RJM. Non-operative Treatment of Spontaneous Spinal Epidural Hematomas: A Review of the Literature and a Comparison with Operative Cases. Acta Neurochir (Wien) 2004;146:103-10. PMid:14963742.
Baek BS, Hur JW, Kwon KY, Lee HK. Spontaneous Spinal Epidural Hematoma. J Korean Neurosurg Soc 2008;44:40-2. PMid:19096655 PMCid:PMC2588288.
Henderson RD, Pittock SJ, Piepgras DG, Wijdicks EFM. Acute Spontaneous Spinal Epidural Hematoma. Arch Neurol 2001;58:1145-6. PMid:11448306.
Fukui MB, Swarnkar AS, William RL. Acute Spontaneous Spinal Epidural Hematomas. AJNR Am J Neuroradiol 1999;20:1365-72.
Tawk C, Moussa MEH, Zgheib R, Nohra G. Spontaneous Epidural Hematoma of the Spine Associated with Oral Anticoagulants: 3 Case Studies. Int J Surg Case Rep 2015;13:8-11. PMid:26074484 PMCid:PMC4529632.
Htwe O, Naicker AS, Pei TS. Spinal epidural hematoma due to anticoagulant therapy: A case report and literature review. Eur J Gen Med 2016;13(3):61-2.
Matsumura A, Namikawa T, Hashimoto R, Okamoto T, Yanagida I, Hoshi M, Noguchi K, Takami M. Clinical Management for Spontaneous Spinal Epidural Hematoma: Diagnosis and Treatment. Spine J 2008;8:534-7. PMid:17434807.
Falavigna A, Righesso O, Teles AR, Hoesker T. Spontaneous Idiopathic Spinal Epidural Hematoma: Two Different Presentations of the Same Disease. Coluna/Columna 2010;9(3):338-42.
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