Warfarin-associated Intraspinal Hematoma.

Area of Science:

• Neurology
• Hematology
• Neurosurgery

Background:

• Warfarin is a common anticoagulant used for preventing systemic embolism in patients with non-valvular atrial fibrillation.
• Intracerebral hemorrhage is a known complication of warfarin, but intraspinal hematoma is exceptionally rare.
• Delayed diagnosis of intraspinal hematoma can occur due to atypical presentations.

Observation:

• A 65-year-old male on warfarin presented with acute urinary retention, initially attributed to benign prostatic hyperplasia.
• The patient later developed painless paraparesis, prompting further investigation.
• Magnetic resonance imaging confirmed a thoracic intraspinal hematoma (Th7-8) with a high international normalized ratio (3.33).

Findings:

• Despite vitamin K administration, warfarin's anticoagulant effect persisted, leading to progressive paraplegia.
• Urgent surgical decompression and hematoma evacuation were performed.
• The patient showed partial recovery of motor function post-surgery.

Implications:

• Intraspinal hematoma should be considered in the differential diagnosis for warfarin users presenting with acute urinary retention.
• While evidence-based guidelines are lacking, surgical management is indicated for progressive neurological deficits.
• This case highlights the importance of considering rare but serious complications of anticoagulation therapy.