Soonchunhyang Med Sci.  2015 Dec;21(2):91-94. 10.0000/sms.2015.21.2.91.

Sudden Hemiplegia by Epidural Hematoma in a Patient Treated with Warfarin and Therapeutic Range International Normalized Ratio

• Seo HW
• Park HW
• Lee KH
• Ahn JH
• Yoon NS
• Cho JG

• KMID: 2317763
• DOI: http://doi.org/10.0000/sms.2015.21.2.91

Abstract

Spontaneous spinal epidural hematoma is extremely rare. It can cause fatal complication such as permanent neurologic deficit. Even though the exact cause of epidural hematoma is not known in most cases, anticoagulation treatment is associated in some cases. In this situation, prompt reversal of anticoagulation and immediate decompression surgery is required. Seventy-year-old woman presesnted with sudden hemiplegia. She had history of hypertension, dyslipidemia, and paroxysmal atrial fibrillation and had taken antihypertensive agent, statin, and warfarin. She did not have any history of trauma and her international normalized ratio was within therapeutic range during follow-up and at the time of event. Physical examination revealed decreased right extremities' motor and sensory function but cognitive function was normal. Detailed neurologic examination and spinal magnetic resonance imaging identified extensive, spontaneous spinal epidural hematoma. After the reversal of anticoagulation with vitamin K injection, the patient underwent emergent hematoma removal surgery and recovered completely. Our case suggests epidural hematoma should be considered in sudden hemiplegia patients with anticoagulation therapy. Immediate reversal of anticoagulation and decompression surgery can avoid neurologic deficit.

Keyword

Hemiplegia; Epidural hematoma; Warfarin

MeSH Terms

Atrial Fibrillation
Decompression
Dyslipidemias
Female
Follow-Up Studies
Hematoma*
Hematoma, Epidural, Spinal
Hemiplegia*
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Hypertension
International Normalized Ratio*
Magnetic Resonance Imaging
Neurologic Examination
Neurologic Manifestations
Physical Examination
Sensation
Vitamin K
Warfarin*
Vitamin K
Warfarin