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Background: Anticoagulants are used mainly in the prevention of venous thromboembolism. The frequency of haemorrhagic complications is correlated with patients’ age and level of International Normalized Ratio (INR). Spontaneous intramedullary spinal cord haemorrhage due to anticoagulation therapy is an extremely rare occurrence. A 62-year old male was admitted to hospital with acute abdominal pain and paraplegia. Because of persistent atrial fibrillation and previous history of ischaemic stroke, on admission the patient was treated with anticoagulant, INR – 15. MRI revealed an abnormal fusiform hyperintesity area in the spinal cord. ‘Haemo’ sequence confirmed the presence of hemosiderin deposits at the level of Th5 – Th7. Anticoagulation therapy might be a cause of spontaneous intramedullary spinal cord haemorrhage. Maintaining high levels of clinical suspicion and utilizing MRI with additional ‘haemo’ option may help in making the right diagnosis.