warfarin and Paralysis

A 71-year-old woman on warfarin (2.5 mg daily) developed severe low back pain with reduced touch sensation and weakness of the lower limbs that progressed to complete paralysis within 28 to 30 hours. Imaging revealed bleeding at the D4 through D11 level, however the patient refused emergency laminectomy. No recovery was observed and the patient was discharged to a rehabilitation facility. Only few other cases of hematomyelia linked to anticoagulant therapy have been reported. Early diagnosis, appropriate management and immediate intervention are needed to prevent irreversible neurological sequelae. The elusive clinical features at presentation may cause an important diagnostic delay.

Topics: Aged; Anticoagulants; Antifibrinolytic Agents; Delayed Diagnosis; Female; Humans; Low Back Pain; Paralysis; Plasma; Spinal Cord Vascular Diseases; Vitamin K; Warfarin

Topics: Aged; Anticoagulants; Aortic Valve; Arm; Arm Injuries; Compartment Syndromes; Heart Valve Prosthesis; Hematoma; Humans; Long-Term Care; Male; Nerve Compression Syndromes; Nerve Regeneration; Neurologic Examination; Paralysis; Rupture; Tendon Injuries; Warfarin

Topics: Cranial Nerve Diseases; Humans; Hypoglossal Nerve; Laryngeal Masks; Male; Middle Aged; Paralysis; Thrombophlebitis; Warfarin

We present the case of a 28-year-old man on chronic warfarin therapy who sustained a minor muscle tear and developed increasing pain and a flexure contracture of the right hip. Surgical exploration revealed an iliopsoas hematoma and femoral nerve entrapment, resulting in a femoral nerve palsy and partial loss of quadriceps functions. Anticoagulant-induced femoral nerve palsy represents the most common form of warfarin-induced peripheral neuropathy; it is characterized by severe pain in the inguinal region, varying degrees of motor and sensory impairment, and flexure contracture of the involved extremity.

Topics: Adult; Femoral Nerve; Hematoma; Humans; Male; Muscular Diseases; Nerve Compression Syndromes; Paralysis; Thigh; Warfarin

Topics: Animals; Blood Coagulation; Cimetidine; Drug Synergism; Guanidines; Kinetics; Liver; Male; Paralysis; Pentobarbital; Rats; Time Factors; Warfarin; Zoxazolamine

Of five patients in who sciatic paresis developed as the result of hemorrhage and hematoma following hip surgery, four were receiving prophylactic or therapeutic anticoagulants. The patient who was managed expectantly still had disabling motor and sensory deficity at follow-up. Three patients who had early operative decompression showed more complete return of nerve function. The fifth patient died three weeks after onset with the neuropathy still present. Severe low-back and buttock pain, ecchymosis over these regions, marked swelling in the thigh, sciatic-nerve tenderness, and a distal sciatic neural deficit in the ipsilateral lower limb of a patient who has had hip surgery are evidence of hemorrhage in the vicinity of the sciatic nerve. Early recognition and prompt surgical decompression can prevent irreversible nerve damage.

Topics: Adolescent; Adult; Aged; Arthroplasty; Female; Hematoma; Hemorrhage; Heparin; Hip Joint; Humans; Leg; Male; Middle Aged; Muscles; Muscular Diseases; Nerve Compression Syndromes; Paralysis; Postoperative Care; Sciatic Nerve; Warfarin

Sixteen strains of mice were compared with respect to their hexobarbitone sleeping time and their zoxazolamine paralysis time. The strains were A2G, CBA, CE, C3H, C57BL, C57L, DBA, F/st, ICFW, NMRI, NZB, Schneider, Simpson, SM, TO and 129/rr. All the strains except 129 Rr were also tested for survival on a diet containing 0.05% racemic Warfarin. There was highly significant interstrain correlation between hexobarbitone sleeping time and zoxazolamine paralysis time (r = 0.72) and between hexobarbitone sleeping time Warfarin survival (r = 0.68). There was a significant correlation between zoxazolamine paralysis time and Warfarin survival (r = 0.56). The correlations can be explained if: (1) there is a genetically determined interstrain variable which is some common component of the microsomal mixed-function oxidase systems involved in the hydroxylation of the three substances; (2) the anticoagulant action of Warfarin is caused more by a hydroxylated metabolite of Warfarin than by Warfarin itself. Phenobarbitone pretreatment shortened hexobarbitone sleeping times and zoxazolamine paralysis times, but its effect was greater in those strains with longer initial hexobarbitone sleeping times and zoxazolamine paralysis times. Piperonyl butoxide pretreatment lengthened hexobarbitone sleeping times, but had no effect on zoxazolamine paralysis times. Warfarin survival was unaltered by pretreatment with either phenobarbital or piperonyl butoxide.

Topics: Animals; Female; Hexobarbital; Male; Mice; Mice, Inbred Strains; Microsomes, Liver; Paralysis; Sex Factors; Sleep; Species Specificity; Warfarin; Zoxazolamine

Topics: Arthritis, Juvenile; Arthritis, Rheumatoid; Arthroplasty; Female; Follow-Up Studies; Hematoma; Heparin; Hip; Hip Joint; Humans; Joint Prosthesis; Male; New York City; Osteoarthritis; Paralysis; Peroneal Nerve; Postoperative Care; Postoperative Complications; Pulmonary Embolism; Splints; Surgical Wound Infection; Thromboembolism; Warfarin; Wound Healing

Topics: Aged; Anticoagulants; Female; Hemorrhage; Humans; Myocardial Infarction; Paralysis; Sciatic Nerve; Warfarin

Topics: Adult; Anticoagulants; Coumarins; Female; Hematoma, Epidural, Cranial; Humans; Laminectomy; Male; Middle Aged; Myelography; Myocardial Infarction; Paralysis; Pulmonary Embolism; Warfarin

Topics: Alcohols; Amobarbital; Animals; Antipyrine; Benzazepines; Blood Coagulation; Chloral Hydrate; Chlordiazepoxide; Enzyme Induction; Ethanol; Fluorometry; Half-Life; Humans; Hydrocortisone; Hypnotics and Sedatives; Ketones; Kinetics; Male; Metabolism; Microsomes, Liver; Morphinans; Nitro Compounds; Paralysis; Phenobarbital; Rats; Rheumatic Heart Disease; Secobarbital; Sleep; Time Factors; Warfarin

Topics: Administration, Oral; Barbiturates; Humans; Injections, Intravenous; Kinetics; Muscle Contraction; Paralysis; Pharmaceutical Preparations; Prothrombin; Succinylcholine; Time Factors; Warfarin