Multiple non-contiguous anticoagulation-related spontaneous acute spinal intradural extramedullary hemorrhages

Author:

Brooks Christopher Alan1,Mahajan Sameer2,Choy Wen Jie3,Rajah Jayant3,Damodaran Omprakash23

Affiliation:

1. Department of Neurosurgery, Waikato Hospital, Hamilton, New Zealand,

2. Department of Neurosurgery, Concord Repatriation General Hospital, Concord, Australia,

3. Department of Neurosurgery, Nepean Hospital, Kingswood, Sydney, Australia.

Abstract

Background: Spinal intradural extramedullary hemorrhage is a rare and important pathology that may precipitate acute compressive myelopathy. It is most commonly associated with spinal trauma, neoplasia, vasculopathy, and iatrogenesis. In rare circumstances, it occurs spontaneously secondary to anticoagulant and antiplatelet medications without an underlying structural lesion. In these instances, it may be related to vasculopathy and/ or cardiovascular disease risk factors. We highlight the salient clinical and radiological features of this pathology, discuss putative mechanisms of its pathogenesis, and describe surgical considerations related to its management. Case Description: This report describes an elderly gentleman who presented with two discrete spinal hemorrhages associated with separate foci of bleeding, in the context of therapeutic anticoagulation, on a background of significant structural and functional cardiovascular disease with risk factors. Conclusion: Our report is novel in that there are no other cases, to the best of our knowledge, of multiple non-contiguous anticoagulation-related spontaneous acute spinal intradural extramedullary hemorrhages in the medical literature. This article is written with the purpose of assisting clinicians to recognize and expedite treatment of this rare pathology. Prompt diagnosis followed by urgent decompressive surgery provides the best functional outcomes.

Publisher

Scientific Scholar

Subject

Neurology (clinical),Surgery

Reference11 articles.

1. A spinal haematoma occurring in the subarachnoid as well as in the subdural space in a patient treated with anticoagulants;Bernsen;Clin Neurol Neurosurg,1992

2. Spinal subdural haematoma: A study of three cases;Boukobza;Clin Radiol,2001

3. Acute nontraumatic spinal intradural hematoma in a patient on warfarin;Bruce-Brand;J Emerg Med,2013

4. Spontaneous spinal subdural hematoma associated with low-molecular-weight heparin. Case report;Cha;J Neurosurg Spine,2005

5. Nontraumatic acute spinal subdural hematoma: Report of five cases and review of the literature;Domenicucci;J Neurosurg,1999

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