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Warfarin-related epidural hematoma: a case report
Xiaoting Li1, Zhaohao Zeng1, Ying Yang1
1Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.
The Journal of International Medical Research
|March 23, 2022
Summary
Spinal epidural hematomas are rare, especially when caused by anticoagulation therapy like warfarin. Early recognition is crucial, as delayed diagnosis can lead to poor patient outcomes.
Area of Science:
- Neurology
- Neurosurgery
- Hematology
Background:
- Spinal epidural hematomas (SEH) are uncommon, typically resulting from trauma.
- Long-term warfarin therapy, used for conditions like atrial fibrillation, elevates the risk of SEH due to coagulation dysfunction.
- Neurological deficits below the affected spinal cord level are characteristic clinical manifestations.
Observation:
- A case report of an nearly 80-year-old female on long-term warfarin therapy presenting with acute waist pain and subsequent lower limb weakness.
- Initial computed tomography (CT) scans were inconclusive for hematoma.
- Delayed contrast-enhanced CT revealed significant intraspinal hematomas at T5-T8 and T12-L2 levels.
Findings:
- Surgical decompression and hematoma removal (T3-T7 laminectomy, T5-T8 hematoma removal) were performed.
- Postoperative neurological improvement was limited, suggesting potential for delayed diagnosis and treatment.
- The rarity of SEH in anticoagulated patients contributes to delayed recognition and misdiagnosis.
Implications:
- Clinicians must maintain a high index of suspicion for SEH in anticoagulated patients presenting with neurological deficits.
- Prompt diagnosis using advanced imaging like MRI is essential for timely intervention.
- Understanding the increased risk associated with anticoagulation therapy is vital for effective patient management.
