Open AccessA Case of Spontaneous Spinal Epidural Haematoma in the Emergency Department Associated with Warfarin Therapy
Author(s) -
Yardan T,
Baydin A,
Genc S,
Cokluk C,
Acar E,
Aydin K
Publication year - 2010
Publication title -
hong kong journal of emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.145
H-Index - 12
eISSN - 2309-5407
pISSN - 1024-9079
DOI - 10.1177/102490791001700410
Subject(s) - medicine , emergency department , paraplegia , warfarin , surgery , laminectomy , hypoesthesia , anesthesia , magnetic resonance imaging , lumbar puncture , neurological examination , atrial fibrillation , radiology , spinal cord , cerebrospinal fluid , psychiatry
Spontaneous spinal epidural haematoma (SSEH) is a neurosurgical emergency that requires early diagnosis and treatment. An 88‐year‐old man presented to the emergency department with complaints of weakness in the legs, walking deficit, incontinence and back pain for the last two days. He had been on warfarin therapy for 5 years for atrial fibrillation. There was no antecedent trauma. The neurological examination revealed hypoesthesia below the T6 level, anaesthesia below the T10 level and complete paraplegia of both lower extremities. The INR level was 7.81 on admission. Magnetic resonance imaging revealed a posterolateral epidural haematoma extending from T2 to L5. He was given fresh frozen plasma and vitamin K in the emergency department. Emergency thoracic and lumbar laminectomy was performed by neurosurgeons. The probability of SSEH should be investigated in any patient under anticoagulation therapy who presents with signs of spinal compression in the emergency department.