Spontaneous Spinal Epidural Hematoma Secondary to Rivaroxaban Use in a Patient With Paroxysmal Atrial Fibrillation

Spontaneous Spinal Epidural Hematoma Under Rivaroxaban and Clopidogrel: A Case Report and Literature Review

Spontaneous spinal epidural hematoma (SSEH) is a rare pathology with potentially severe consequences for the patient. Given its uncommon incidence and frequent atypical presentation, SSEH can easily be misdiagnosed. The association between anticoagulation or antiplatelet therapy and SSEH has been described in multiple case reports and literature reviews. We present a case of a 61-year-old man on anticoagulation and antiplatelet therapy (Rivaroxaban and Clopidogrel respectively), diagnosed with spinal SSEH with good recovery after laminectomy and hematoma evacuation. However, treatment guidelines for SSEH are difficult to find and there is no clear strategy about management of anticoagulation and antiplatelet therapy. The aim of this report is to highlight the importance of rapid diagnosis and surgical therapy in selected cases and to give an insight on the anticoagulation and antiplatelet management in these patients and their prognosis.

New oral anticoagulants-induced spinal epidural haematomas: case series and review of literature

Spontaneous spinal epidural haematoma (SSEH) is a rare cause of acute spinal cord compression. This condition is often associated with use of anticoagulant drugs, coumarins or new oral anticoagulants, such as direct factor Xa inhibitor and direct thrombin inhibitor. The manifestation of severe neurological deficits is common and can lead to catastrophic consequences if not diagnosed early. Standard therapy is decompressive laminectomy, although spontaneous recoveries have been reported. Due to the rarity of this pathologic entity, only sporadic case reports and associated reviews are available. We report a case series of 4 patients diagnosed with spontaneous spinal epidural haematoma induced by new oral anticoagulants. Spontaneous spinal haematoma is a rare pathologic entity and therefore difficult to diagnose. For patients receiving long term anti-coagulant therapy, SSEH should be included in the differential diagnosis. Prompt surgical evacuation of the haematoma and haemostasis leads to favourable neurological outcome, whereas delay in treatment can be disastrous.

Spontaneous epidural and subdural hematomas of the spine: Review of anatomy and imaging findings

Spontaneous epidural (SEH) and subdural hematomas (SSH) of the spine are a rare cause of spinal injury and morbidity. They often present in the emergency setting, though magnetic resonance imaging is the gold-standard for diagnosis. Knowledge of anatomy, and in particular of the dural layers of the spine, is crucial to understand the location of SEH and SSH and their relationship with spinal structure. In this pictorial review, we aim to explain imaging features of the SEH and SSH, and to rule out their main differential diagnosis.

Warfarin-related epidural hematoma: a case report

Spinal epidural hematomas are rare, with trauma being the most common cause. Spinal epidural hematomas caused by coagulation dysfunction are even rarer; however, long-term warfarin therapy increases the risk. The clinical manifestations of spinal epidural hematoma are neurological deficits below the corresponding spinal cord segment level. Magnetic resonance imaging (MRI) is the preferred method for diagnosis, and the main treatment for epidural hematoma with typical symptoms is urgent decompression of the lumbar spine. We describe an almost 80-year-old female patient who received long-term oral warfarin therapy for atrial fibrillation. She developed sudden onset waist pain, and 2 days later, she developed pain and weakness in both lower limbs. Computed tomography (CT) of the thoracolumbar spine showed no obvious hematoma. Eight days after admission, contrast-enhanced CT of the thoracolumbar spine showed intraspinal hematomas at T5–T8 and T12–L2 levels. We performed T3–T7 laminectomy, T5–T8 hematoma removal, and spinal dural repair. The clinical symptoms did not improve significantly, postoperatively. The low incidence of spinal epidural hematoma after anticoagulation treatment means this condition is not recognized timely, and it is misdiagnosed easily. Clinicians should consider this condition when patients treated with anticoagulants have neurological deficits below a spinal segmental plane.