Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Oct 24;5(10):000951.
doi: 10.12890/2018_000951. eCollection 2018.

Spontaneous Spinal Intradural Haematoma in an Anticoagulated Woman

Geetha Girithari  1 , Inês Coelho Dos Santos  1 , Tiago Alves  1 , Eva Claro  1 , Marcia Kirzner  1 , Ana Luisa Massano  2
Affiliations

Spontaneous Spinal Intradural Haematoma in an Anticoagulated Woman

Geetha Girithari et al. Eur J Case Rep Intern Med. .

Abstract

A 57-year-old woman, with a history of deep venous thrombosis and medicated with warfarin, presented at the hospital with acute back pain with paraplegia, headache, high blood pressure and vomiting. Imaging of the spine showed an acute intradural extramedullary haemorrhage with blood clot formation. The patient underwent surgery and received intensive post-surgical physiotherapy but remains paraplegic. Non-traumatic spinal intradural extramedullary haematoma (SIEH) is a rare neurological emergency that can result in spinal cord compression. Physicians should always consider this clinical entity as a differential diagnosis, especially in a patient presenting with acute back pain on anticoagulant therapy.

Learning points: Non-traumatic spinal intradural extramedullary haematoma is extremely rare.Acute cases can lead to spinal cord compression.Physicians should consider this clinical entity in anticoagulated patients presenting with acute onset of back or radicular pain followed by paraplegia, intestinal and bladder dysfunction.

Keywords: Spinal intradural extramedullary haematoma; anticoagulation; spinal subdural haematoma.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interests: The Authors declare that there are no competing interests.

Figures

Figure 1
Figure 1
Initial CT scan with a suggestion of intradural hyperintensity between T4 and T8 (between arrows) with probable compression and deviation of the spinal cord
Figure 2
Figure 2
Spinal MRI showing intradural extramedullary haemorrhage at T4–T8
Figure 3
Figure 3
MRI image 1 week after surgery showing a retro-thecal pseudo meningocele extending to the retro-vertebral muscular layers, subcutaneous tissue with a fistula extending to the skin on the right side at the T1–T2 level, and medullary oedema from T3 to T9
See this image and copyright information in PMC

References

    1. Bruce-Brand RA, Colleran GC, Broderick JM, Lui DF, Smith EM, Kavanagh EC, et al. Acute nontraumatic spinal intradural hematoma in a patient on warfarin. J Emerg Med. 2013;45:695–697. - PubMed
    1. Kirsch E, Gratzl O, Mindermann T, Hausmann O, Radu E. Coagulopathy induced spinal intradural extramedullary haematoma: report of three cases and review of the literature. Acta Neurochir (Wien) 2001;143:135–140. - PubMed
    1. Pereira BJ, de Almeida AN, Muio VM, de Oliveira JG, de Holanda CVM, Fonseca NC. Predictors of outcome in nontraumatic spontaneous acute spinal subdural hematoma: case report and literature review. World Neurosurg. 2016;89:574–577. - PubMed
    1. Dampeer RA. Spontaneous spinal subdural hematoma: case study. Am J Criti Care. 2009;19:191–193. - PubMed
    1. de Beer MH, Eysink Smeets MM, Koppen H. Spontaneous spinal subdural hematoma. Neurologist. 2017;22:34–39. - PubMed

LinkOut - more resources