Spontaneous spinal epidural haematoma: management and main risk factors in era of anticoagulant / antiplatelet treatment

Spinal epidural haematoma is a rare condition, which may be due to trauma, surgery, epidural catheterisation or disorders of coagulation. We report a case of 60 year old lady who was on warfarin for Atrial fibrillation (AF) presented with history of non-traumatic sudden onset pain in both legs and difficulty in walking. Magnetic resonance imaging (MRI) spine demonstrated epidural haematoma which was treated conservatively. Another dilemma was anticoagulation for AF. We examine the options to manage such case.

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Spinal epidural haematoma following rivaroxaban administration after total knee replacement

Indian Journal of Anaesthesia ◽

10.4103/0019-5049.163006 ◽

2015 ◽

Vol 59 (8) ◽

pp. 519 ◽

Cited By ~ 8

Author(s):

KoteshwaraRao Madhisetti ◽

Mohan Mathew ◽

Mallie George ◽

SureshS Pillai

Keyword(s):

Total Knee Replacement ◽

Knee Replacement ◽

Epidural Haematoma ◽

Spinal Epidural Haematoma ◽

Total Knee ◽

Spinal Epidural

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Spinal epidural haematoma: MRI-aided diagnosis

Journal of Clinical Neuroscience ◽

10.1054/jocn.2001.0918 ◽

2002 ◽

Vol 9 (1) ◽

pp. 92-94 ◽

Cited By ~ 7

Author(s):

Wai Hoe Ng ◽

C.C. Tchoyoson Lim ◽

Puay Yong Ng ◽

Kheng Kooi Tan

Keyword(s):

Epidural Haematoma ◽

Spinal Epidural Haematoma ◽

Spinal Epidural ◽

Aided Diagnosis

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A patient with delayed traumatic cervical spinal epidural haematoma presenting with hemiparesis

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2009.02.030 ◽

2010 ◽

Vol 17 (3) ◽

pp. 404-405 ◽

Cited By ~ 8

Author(s):

James Dimou ◽

Rondhir Jithoo ◽

Steven Bush

Keyword(s):

Epidural Haematoma ◽

Spinal Epidural Haematoma ◽

Spinal Epidural

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Cauda equina syndrome due to Factor Xa inhibitor (Rivaroxaban): Case report and review of literature

Case Reports in Clinical Pathology ◽

10.5430/crcp.v7n1p7 ◽

2020 ◽

Vol 7 (1) ◽

pp. 7

Author(s):

SR Gowda ◽

PJ O’Hagan ◽

JT Griffiths

Keyword(s):

Cauda Equina Syndrome ◽

Cauda Equina ◽

Factor Xa ◽

Epidural Haematoma ◽

Sudden Onset ◽

Lower Limbs ◽

Spontaneous Bleeding ◽

Gradual Improvement ◽

Spinal Epidural Haematoma ◽

Spinal Epidural

Background: Factor Xa inhibitors are widely used by the physicians to reduce the incidence of thrombosis in order to protect the cardiovascular function. Although complications of bleeding and spontaneous gastrointestinal sources have been reported before, there are very sporadic cases of spinal epidural haematoma causing neurological compromise. Case presentation: We report a case of spontaneous spinal epidural haematoma (SSEH) in an 85-year-old female patient treated with Rivaroxaban, a new agent to prevent the incidence of thrombo-embolic events. Anticoagulant therapy is a recognised risk factor in the development of spontaneous bleeding and haematomas. The patient presented to the emergency department with sudden onset of severe back pain in the lumbar spine associated with paraplegia in the lower limbs. Magnetic resonance imaging (MRI) of the spine demonstrated a SSEH from T12 to L5 affecting the cauda equina. Rivaroxaban was discontinued and the patient was monitored as an inpatient. There was gradual improvement in the symptoms of the lower limbs. Conclusion: This rare condition of incomplete cauda equina syndrome due to Rivaroxaban therapy has not been reported previously. Clinicians must have a high index of suspicion in patients on regular anti-coagulation regimen.

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