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Spontaneous thoracolumbar epidural hematoma in an apixaban anticoagulated patient
Andreas Theofanopoulos1, Petros Zampakis2, Eleftheria Antoniadou3
1Department of Neurosurgery, University of Patras, University Hospital of Patras, Achaia, Greece.
Background:
Spontaneous spinal epidural hematomas (SSEHs) are often attributed to anticoagulation. Although they are rare, they may contribute to significant morbidity and mortality.
Case Description:
An 83-year-old female with a history of atrial fibrillation on apixaban, presented with 4 days of back pain, progressive lower extremity weakness and urinary retention. When the patient's MRI showed a dorsal thoracolumbar SSEH, the patient underwent a T10-L3 laminectomy for hematoma evacuation. Within 2 postoperative months, her neurological deficits fully resolved.
Conclusion:
Apixaban is associated with SSEH resulting in severe neurological morbidity and even mortality. Prompt MRI imaging followed by emergency surgical decompressive surgery may result in full resolution of neurological deficits.
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