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Spontaneous chronic epidural hematoma in the lumbar spine associated with Warfarin intake: a case report

Axel Sandvig1, Håkan Jonsson2

  • 1Division of Neurosurgery and Clinical Neurophysiology, Department of Pharmacology and Clinical Neurosciences, Umeå University Hospital, Umeå, Sweden ; Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.

Springerplus
|November 8, 2016
PubMed
Abstract

Insights

Spinal epidural hematomas are rare but can occur in patients taking warfarin. This case highlights how these hematomas may mimic disc issues, emphasizing the need for awareness in anticoagulated individuals.

Area of Science:

  • Neurology
  • Neurosurgery
  • Radiology

Background:

  • Spontaneous spinal epidural hematomas (SSEH) are uncommon neurological emergencies.
  • Anticoagulant therapy, such as warfarin, may increase the risk of SSEH.
  • Patients may present with radiculopathy or progressive neurological deficits.

Purpose of the Study:

  • To report a case of SSEH in a warfarin-treated patient.
  • To illustrate diagnostic challenges and potential misinterpretations of imaging findings.
  • To emphasize the association between warfarin use and SSEH.

Main Methods:

  • Case presentation of a warfarin-treated patient with L5 radiculopathy.
  • Review of MRI findings initially suggestive of lumbar disc prolapse or synovial cyst.
  • Surgical intervention and histological analysis of removed material confirming hematoma.

Main Results:

  • The patient underwent surgery for suspected disc prolapse/cyst, but a hematoma was found.
  • Histological analysis confirmed the presence of a hematoma, not a disc herniation or cyst.
  • Neurological recovery was achieved post-operatively.

Conclusions:

  • SSEH can present with symptoms mimicking common spinal pathologies like disc herniation.
  • Radiological misinterpretation is possible, particularly in patients on anticoagulants.
  • Warfarin therapy is a potential risk factor for SSEH, necessitating clinical vigilance.
Keywords:
Anticoagulant treatmentL5-root compressionMRIRadiculating pain

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