vitamin-k-semiquinone-radical and Hematoma--Subdural--Spinal

We are presenting a case of non-traumatic spontaneous spinal subdural hematoma in a patient on warfarin and fluoxetine. This diagnosis should be considered early in patients who are on warfarin or fluoxetine or both presenting with acute neurological abnormalities of the limbs, and early decompression could result in good neurological outcome.

Topics: Aged; Antifibrinolytic Agents; Back Pain; Blood Coagulation Factors; Combined Modality Therapy; Decompression, Surgical; Dexamethasone; Early Diagnosis; Early Medical Intervention; Fluoxetine; Glucocorticoids; Hematoma, Subdural, Spinal; Humans; Laminectomy; Magnetic Resonance Imaging; Male; Paraplegia; Spinal Cord Compression; Treatment Outcome; Urinary Retention; Vitamin K; Warfarin

Spinal subdural hematoma (SSDH) is a rare condition, which is difficult to diagnose, related to Vitamin K Antagonist. This a case report of a life-threatening situation in a octogenarian patient with a history of recent atrial fibrillation that received K-Vitamin Antagonist (KVA) therapy. The history and the clinical assessment were normal at the admission, associated with increase in the coagulation parameters (INR >10). Twenty-four hours after the admission, the patient developed progressive tetraparesis and a Magnetic Resonance Imaging (MRI) was performed, disclosing the evidence of a SSDH (Figure 1). An emergency neurosurgical intervention was performed associated with normalization of the coagulation parameters. After the procedure, the patient presented improvement of the neurological symptoms.

Topics: Administration, Oral; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Hematoma, Subdural, Spinal; Humans; Male; Vitamin K