Incomplete Brown-Séquard syndrome secondary to acenocoumarol-induced hematomyelia: A case report

Intramedullary spinal cord hemorrhage, also known as hematomyelia, is an uncommon but clinically significant condition. It accounts for approximately 0.82% of all spinal hematomas, making it one of the least frequently encountered etiologies of acute myelopathy. Hematomyelia may result from a variety of causes, including vascular malformations (such as cavernomas or arteriovenous fistulas), bleeding diatheses, spinal cord tumors, trauma, or complications related to anticoagulation therapy.

Here, we describe a patient on acenocoumarol who developed incomplete Brown-Séquard syndrome secondary to spontaneous intramedullary hemorrhage. She presented to the emergency department with a one-week history of progressively worsening headache, neck pain, and left hemithoracic pain. Prompt magnetic resonance imaging allowed diagnosis, and conservative management led to neurological stabilization. Our case underscores the need for timely diagnostic imaging in patients taking anticoagulants who present with new neurological deficits. It also highlights the diagnostic challenges and therapeutic decisions associated with this rare complication.

In some cases, the cause of hematomyelia remains idiopathic. Vitamin K antagonists are widely used for the long-term prevention of thromboembolic events; hence, prompt diagnosis of potential complications is important.