• J Emerg Med · Nov 2013

    Case Reports

    Acute Nontraumatic Spinal Intradural Hematoma in a Patient on Warfarin.

    • Robert A Bruce-Brand, Gabrielle C Colleran, James M Broderick, Darren F Lui, Eimear M Smith, Eoin C Kavanagh, and Ashley R Poynton.
    • Department of Trauma and Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
    • J Emerg Med. 2013 Nov 1; 45 (5): 695-7.

    BackgroundNontraumatic spinal intradural extramedullary hematomas are extremely rare. When they occur, they can rapidly lead to spinal cord or cauda equina compression and have devastating consequences.ObjectiveThe aim here was to report a case of this rare phenomenon and discuss the etiology, imaging, management, and outcome of intradural hematomas.Case ReportWe describe the case of a 76-year-old man on warfarin therapy who presented with severe lower back pain and flaccid paraparesis. Blood tests revealed an international normalized ratio of 6.0. A magnetic resonance imaging result suggested an intradural hematoma extending from L1 to L4 and compressing the spinal cord and cauda equina. Emergency surgical decompression revealed an extensive intradural extramedullary hematoma, which was evacuated. The patient showed only minor neurologic improvement 6 months postoperatively.ConclusionsCoagulopathy-induced spinal hemorrhage should be included in the differential diagnosis for patients presenting with signs of acute spinal cord compression.Copyright © 2013 Elsevier Inc. All rights reserved.

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