Abstract
Spontaneous spinal subdural hematomas are extremely rare. Most spinal hematomas are discovered in the epidural space. In the majority of cases, spontaneous hematomas are idiopathic. However, when attributed to anticoagulation therapy coumarins are more common than direct factor Xa inhibitors such as apixaban. Previous reports have linked direct factor Xa inhibitors with intracranial subdural hematomas much more frequently than spinal subdural hematomas. The manifestation of severe neurological deficits, such as sensorimotor disturbances and loss of sphincter control, is common and is considered a surgical emergency. The present case consists of a patient with a spontaneous spinal thoracic subdural hematoma secondary to apixaban use with loss of sphincter control and paraplegia. After 6 months of follow-up, the patient recovered completely.
Highlights
Spinal subdural hematomas (SSDHs) are quite rare, as they appear much less frequently than intracranial subdural hematomas and spinal epidural hematomas
The present case consists of a patient with a spontaneous spinal thoracic subdural hematoma secondary to apixaban use with loss of sphincter control and paraplegia
The following report consists of a rare case of a spontaneous thoracic subdural hematoma associated with paraplegia and sphincter dysfunction secondary to apixaban use
Summary
Spinal subdural hematomas (SSDHs) are quite rare, as they appear much less frequently than intracranial subdural hematomas and spinal epidural hematomas. The following report consists of a rare case of a spontaneous thoracic subdural hematoma associated with paraplegia and sphincter dysfunction secondary to apixaban use. Patient presented sudden onset with dorsal pain followed immediately by bilateral lower extremity paresis that progressed to complete paraplegia with bowel and bladder dysfunction over 15 min. Patient is taken to the operating room immediately, where a wide laminectomy was performed from T4 to T7, durotomy and drainage of subdural hematoma (Figs 3 and 4). The 24 h post-operative patient persists with bowel and bladder dysfunction, mobilizes lower extremities (muscle strength 2/5). Three months post-operative, full recovery of muscle strength, but still persists with bladder problems, but since they are mild.
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