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. 2015:13:8-11.
doi: 10.1016/j.ijscr.2015.05.022. Epub 2015 May 29.

Spontaneous epidural hematoma of the spine associated with oral anticoagulants: 3 Case Studies

C Tawk  1 , M El Hajj Moussa  2 , R Zgheib  3 , G Nohra  4
Affiliations

Spontaneous epidural hematoma of the spine associated with oral anticoagulants: 3 Case Studies

C Tawk et al. Int J Surg Case Rep. 2015.

Abstract

Introduction: Spontaneous epidural hematoma of the spine (SEHS) is an extremely rare entity. Patients known to have thrombophilia or on anticoagulant drugs are the most affected. It is generally caused by a rupture of the postero-internal vertebral venous plexus secondary to minor barotrauma such as cough, peridural catheter insertion... Early diagnosis and treatment showed to have the best outcome.

Cases report: We report 3 cases of spontaneous epidural hematoma in patients treated by acenocoumarol, which occurred without any provocative factor. All 3 patients were treated with decompressive laminectomy.

Discussion: We described the MRI findings and discussed the spontaneity of the entity. Our present case studies and the review of the literature showed that early diagnosis and management of SEHS can lead to improvement of the neurological state and avoid definitive motor and sensitive deficit.

Conclusion: This rare entity should be suspected in every acute medullary syndrome with spinal pain, motor and/or sensory deficit. In order to decrease the sequelae, neurologically unstable patients should benefit from early diagnosis and urgent surgical decompression.

Keywords: Acenocoumarol; Oral anticoagulants; Spontaneous epidural hematoma of the spine.

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Figures

Fig. 1
Fig. 1
Sagittal T2 weighted MRI with spinal cord compression from C2 to D2.
Fig. 2
Fig. 2
Sagittal T2 weighted MRI showing a subdural hematoma compressing the spinal cord and cauda equina from L1 to L4.
Fig. 3
Fig. 3
Sagittal T2 weighted MRI showing the extradural hematoma compressing the spinal cord from D8 to D12.
Fig. 4
Fig. 4
Axial T2 weighted MRI showing an extradural hematoma compressing the left hemicord.
Fig. 5
Fig. 5
Sagittal cervical T2 weighted MRI revealing an extradural hematoma from C3 to C5.
See this image and copyright information in PMC

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