Spontaneous chronic epidural hematoma in the lumbar spine associated with Warfarin intake: a case report.

Axel Sandvig,Håkan Jonsson

doi:10.1186/s40064-016-3546-x

Abstract

IntroductionSpontaneous spinal epidural hematomas are rare. However, in patients on anticoagulant treatment the risk may increase. Symptomatically patients may present with radiculopathy and even progressive neurological deficits.Case descriptionWe present a case of a warfarin treated patient with left L5 radiculopathy. MRI was evaluated as showing a lumbar disc prolapse or synovial cyst at L4–L5 level. The patient was operated and an organized material was removed and analysed as a hematoma. No prolapsed disc or synovial cyst was found. The patient was neurologically restored following the operation.Discussion and EvaluationThis case illustrates how spontaneous epidural spinal hematomas can present with symptoms of radiculopathy and radiologically be misinterpreted as a protruding disc or cyst.ConclusionWarfarin treated patients may have an increased risk of spontaneous spinal epidural hematomas.

Highlights

This case illustrates how spontaneous epidural spinal hematomas can present with symptoms of radiculopathy and radiologically be misinterpreted as a protruding disc or cyst
Epidural spinal hematomas located in the lumbar region are even more rare, if they radiologically mimic a prolapsed disc or a discopathy
Case report We report on a 70-year old male with an atypical spontaneous epidural hematoma

Summary

Introduction

Spontaneous spinal epidural hematomas occur infrequently (Mohammed et al 2015). Epidural spinal hematomas located in the lumbar region are even more rare, if they radiologically mimic a prolapsed disc or a discopathy. The patient has signed an informed written consent to partake in this study His medical history included hypertension and atrial flutter, for which he received anti-coagulant treatment (Warfarin) He had undergone bilateral hip-replacement, the Sandvig and Jonsson SpringerPlus (2016)5:1832 first on the right side and the second on his left side sixteen years later. He presented with progressive lumbar radicular pain anterolaterally down the left leg and dorsomedially over the foot consistent with a left L5-radiculopathy. Upon neurological examination the patient presented with a marked limp on his left foot He was slightly palpation sore over his lumbar processus spinosi and paravertebral lumbar extensor muscles. He made an uneventful recovery with complete remission of his neurological symptoms including radicular pain

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