Atypical Presentation of Atraumatic Spinal Subdural Hematoma Associated with Warfarin: A Case Report and Review of the Literature
Nontraumatic spinal subdural hematomas secondary to anticoagulants are remarkably rare. A case of spontaneous, atraumatic subdural hematoma involving the thoracic region in an 80-year-old woman on warfarin is reported. The patient presented with gross motor and sensory loss, delayed onset of inconti...
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doaj-4763ba41f38f426d836e96969d0c57342020-11-25T00:27:53ZengHindawi LimitedCase Reports in Orthopedics2090-67492090-67572019-01-01201910.1155/2019/40379164037916Atypical Presentation of Atraumatic Spinal Subdural Hematoma Associated with Warfarin: A Case Report and Review of the LiteratureAbdul Rehman Arain0Muhammad Moral1Saadia Shams2Khusboo Desai3Khunwar Kalsa4Department of Orthopedics, Albany Medical College, 1267 Washington Ave Suite 202, Albany, NY 12206, USADepartment of Orthopedics, Albany Medical College, 1267 Washington Ave Suite 202, Albany, NY 12206, USARawalpindi Medical College, PakistanDepartment of Orthopedics, Albany Medical College, 1267 Washington Ave Suite 202, Albany, NY 12206, USADepartment of Orthopedics, Albany Medical College, 1267 Washington Ave Suite 202, Albany, NY 12206, USANontraumatic spinal subdural hematomas secondary to anticoagulants are remarkably rare. A case of spontaneous, atraumatic subdural hematoma involving the thoracic region in an 80-year-old woman on warfarin is reported. The patient presented with gross motor and sensory loss, delayed onset of incontinence, and no other symptoms. An MRI suggested an epidural hematoma concentrated around the T4-T9 levels. She was taken emergently to the OR approximately 30 hours after the initial onset of symptoms for a T3-T11 laminectomy. No epidural hematoma was noted. However, discoloration and bulging of the thecal sac were noted, and the dura was incised longitudinally from T2 to T10 revealing an expansive jelly-like blood clot which was evacuated. Postoperatively, the patient had regained 1/2 sensory function in the bilateral lower extremities. At the 2-week mark, the patient was still incontinent and showed 2/2 sensory and 2/5 motor functions in select muscle groups in her bilateral lower extremities. Completely nontraumatic, spontaneous subdural hematomas of the spine are very rare, and early surgical decompression within 24 hours from symptom onset may allow neurological recovery. Large extensive laminectomies up to 10 thoracic levels have been shown to be safe and effective in a few cases, including our case.http://dx.doi.org/10.1155/2019/4037916 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Abdul Rehman Arain Muhammad Moral Saadia Shams Khusboo Desai Khunwar Kalsa |
spellingShingle |
Abdul Rehman Arain Muhammad Moral Saadia Shams Khusboo Desai Khunwar Kalsa Atypical Presentation of Atraumatic Spinal Subdural Hematoma Associated with Warfarin: A Case Report and Review of the Literature Case Reports in Orthopedics |
author_facet |
Abdul Rehman Arain Muhammad Moral Saadia Shams Khusboo Desai Khunwar Kalsa |
author_sort |
Abdul Rehman Arain |
title |
Atypical Presentation of Atraumatic Spinal Subdural Hematoma Associated with Warfarin: A Case Report and Review of the Literature |
title_short |
Atypical Presentation of Atraumatic Spinal Subdural Hematoma Associated with Warfarin: A Case Report and Review of the Literature |
title_full |
Atypical Presentation of Atraumatic Spinal Subdural Hematoma Associated with Warfarin: A Case Report and Review of the Literature |
title_fullStr |
Atypical Presentation of Atraumatic Spinal Subdural Hematoma Associated with Warfarin: A Case Report and Review of the Literature |
title_full_unstemmed |
Atypical Presentation of Atraumatic Spinal Subdural Hematoma Associated with Warfarin: A Case Report and Review of the Literature |
title_sort |
atypical presentation of atraumatic spinal subdural hematoma associated with warfarin: a case report and review of the literature |
publisher |
Hindawi Limited |
series |
Case Reports in Orthopedics |
issn |
2090-6749 2090-6757 |
publishDate |
2019-01-01 |
description |
Nontraumatic spinal subdural hematomas secondary to anticoagulants are remarkably rare. A case of spontaneous, atraumatic subdural hematoma involving the thoracic region in an 80-year-old woman on warfarin is reported. The patient presented with gross motor and sensory loss, delayed onset of incontinence, and no other symptoms. An MRI suggested an epidural hematoma concentrated around the T4-T9 levels. She was taken emergently to the OR approximately 30 hours after the initial onset of symptoms for a T3-T11 laminectomy. No epidural hematoma was noted. However, discoloration and bulging of the thecal sac were noted, and the dura was incised longitudinally from T2 to T10 revealing an expansive jelly-like blood clot which was evacuated. Postoperatively, the patient had regained 1/2 sensory function in the bilateral lower extremities. At the 2-week mark, the patient was still incontinent and showed 2/2 sensory and 2/5 motor functions in select muscle groups in her bilateral lower extremities. Completely nontraumatic, spontaneous subdural hematomas of the spine are very rare, and early surgical decompression within 24 hours from symptom onset may allow neurological recovery. Large extensive laminectomies up to 10 thoracic levels have been shown to be safe and effective in a few cases, including our case. |
url |
http://dx.doi.org/10.1155/2019/4037916 |
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