warfarin and Paraplegia

Topics: Hematoma, Epidural, Spinal; Humans; Lower Extremity; Paraplegia; Warfarin

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

A case of a large spinal epidural haematoma, in a 58 years old male, leading to paraplegia, in a patient on long-term warfarin treatment is presented. Magnetic Resonance imaging (MRI) of the whole spine showed extensive epidural spinal haematoma distal to C4 level surrounding and displacing the spinal cord and the nerve roots up to T2 level. Near complete neurological recovery followed surgical evacuation and multidisciplinary rehabilitation.

Topics: Anticoagulants; Decompression, Surgical; Diagnosis, Differential; Hematoma, Epidural, Spinal; Humans; Laminectomy; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Middle Aged; Paraplegia; Radiography; Treatment Outcome; Warfarin

To describe a complication of placement of an inferior vena cava (IVC) filter in a man with paraplegia.. Case report.. A 48-year-old man with T11 paraplegia secondary to an L1 burst fracture underwent thoracic spinal fusion. The postoperative course was complicated by deep vein thrombosis (DVT) of the right common femoral vein, which was treated with warfarin.. During rehabilitation, the hematocrit declined, and fluctuance was noted along the surgical site. Computed tomographic scan suggested a hematoma in the paraspinal and latissimus dorsi muscles. Warfarin was discontinued, and an IVC filter was placed. He subsequently developed severe leg pain, followed by hypotension, acute renal failure, and compartment syndrome in bilateral lower extremities requiring fasciotomies. Ultrasound and computed tomographic angiogram showed extensive bilateral lower extremity DVTs and pulmonary emboli. The diagnosis of cerulea dolens was made. Mechanical and pharmacological thrombectomy was aborted secondary to bleeding complications and hypotension. The patient died shortly after care was withdrawn at the family's request. The autopsy revealed multiple thrombi in IVC, bilateral pelvic and femoral veins, and left pulmonary artery embolus, consistent with phlegmasia cerulea dolens.. Inferior vena cava filters may prevent pulmonary embolism but do not affect the underlying thrombotic process. An IVC filter should be recognized as a possible thrombogenic nidus in patients with spinal cord injury who have known DVT.

Topics: Anticoagulants; Fatal Outcome; Humans; Male; Middle Aged; Paraplegia; Pulmonary Embolism; Spinal Cord Injuries; Spinal Fractures; Thrombophlebitis; Tomography, X-Ray Computed; Vena Cava Filters; Venous Thrombosis; Warfarin

A large thrombus entrapped in an atrial septal defect is a rare condition that can lead to life-threatening systemic and pulmonary embolization. The use of thrombolysis may prove dangerous to the patient. Herein, we describe the emergency surgical management that contributed to a successful outcome in a 67-year-old man who was found to have a 23-cm-long thrombus across an atrial septal defect.

Topics: Aged; Anticoagulants; Echocardiography; Heart Septal Defects, Atrial; Heparin; Humans; Male; Paraplegia; Pulmonary Embolism; Thromboembolism; Thrombosis; Vena Cava Filters; Venous Thrombosis; Warfarin

Topics: Abdominal Abscess; Anticoagulants; Aortic Diseases; Arterial Occlusive Diseases; Arteriosclerosis; Calcinosis; Conversion Disorder; Diagnostic Errors; Female; Humans; Hypesthesia; Ischemia; Leg; Middle Aged; Muscle Denervation; Paraplegia; Peripheral Nerves; Thrombosis; Tibial Arteries; Tomography, X-Ray Computed; Warfarin

A case of thoracic hematomyelia secondary to anticoagulant therapy is presented. Clinical features, similar to 2 other previously reported cases, are discussed. A high index of suspicion may lead to a quick diagnostic procedure and successful decompressive surgery.

Topics: Hemorrhage; Humans; Middle Aged; Myelography; Neurologic Examination; Paraplegia; Spinal Cord Diseases; Thrombophlebitis; Tomography, X-Ray Computed; Warfarin

A spontaneous intrapericardial haemorrhage caused cardiac tamponade in a 29 year old paraplegic man who was being treated with warfarin. The associated persistent hyponatraemia, which was believed to be caused by an inappropriately high release of antidiuretic hormone, rapidly resolved after pericardiocentesis.

Topics: Adult; Cardiac Tamponade; Drainage; Humans; Hyponatremia; Inappropriate ADH Syndrome; Male; Paraplegia; Pulmonary Embolism; Warfarin

Although spinal subdural hematoma is a rare condition, it has a higher incidence in persons with a bleeding diathesis and in those with a bleeding diathesis who have had a lumbar puncture. We report a case of a 65-year-old woman on oral anticoagulants presenting with atypical symptoms who developed a spinal subdural hematoma over a six-hour period. This resulted in complete paraplegia of her lower extremities with no improvement after surgical spinal cord decompression.

Topics: Female; Hematoma, Subdural; Hemorrhagic Disorders; Humans; Laminectomy; Middle Aged; Paraplegia; Spinal Cord Compression; Spinal Diseases; Warfarin

Topics: Administration, Oral; Aged; Anticoagulants; Female; Hematoma, Subdural; Herpes Zoster; Humans; Hyperesthesia; Neuralgia; Paraplegia; Prothrombin Time; Warfarin