Spontaneous Spinal Epidural Hematoma Associated With Short-Term Dual Antiplatelet Therapy: A Case Report

Abstract

Spinal epidural hematoma (SEDH), either spontaneous or traumatic, is a rare neurosurgical emergency. Typically, the natural history is a sudden onset of severe neck or back pain, associated with neurological deficit, either immediately or after a short period of the pain onset. MRI is the gold standard investigation. The mainstay of treatment is spinal decompression, in the form of laminectomy or hemilaminectomy, with the evacuation of the hematoma. The occurrence of SEDH has been strongly associated with coagulopathy, especially that induced by anticoagulant use. The association between SEDH and antiplatelet therapy has been scarcely reported in the literature. We report a case of spontaneous SEDH in a patient who was on dual antiplatelet therapy. Our case is unique because the patient had been using antiplatelet agents for only six weeks prior to this diagnosis. As antiplatelet agents are widely prescribed, physicians should be able to anticipate SEDH as a possible complication of dual antiplatelet therapy to facilitate early treatment and better outcomes.

Keywords: antiplatelet therapy; dual antiplatelet therapy; neck pain; quadriparesis; spinal epidural hematoma; stroke mimic.

Figure 1. (A) T1-weighted MRI (sagittal view) showing a hyperintense collection from the C3 level down to the lower border of C7. (B) T2-weighted MRI (axial view) at the C3-4 level, where the hematoma is most prominent, showing complete obliteration of the exiting right nerve root.

Figure 2. Gross intraoperative picture of the epidural hematoma.

Figure 3. T2-weighted MRI of the cervical spine six months postoperatively.

(A) Sagittal view. (B) Axial view at the C3-4 level.