warfarin and Spinal-Cord-Diseases

Warfarin embryopathy is a well-defined manifestation of intrauterine warfarin exposure. The embryopathy phenotype as it relates to the nervous system is broad and poorly recognised. We describe an adult with neurological sequelae of fetal warfarin exposure. We review previous cases with neurological sequelae and discuss the pathogenetic mechanism in light of recent research.

Topics: Abnormalities, Drug-Induced; Adult; Anticoagulants; Cognition Disorders; Deafness; Humans; Male; Nasal Bone; Spinal Cord Diseases; Spine; Warfarin

Spontaneous intraspinal haematomas due to anticoagulants are uncommon, and usually extradural or subdural. Intramedullary haematomas are particularly rare, and only two case reports were found in the literature. We report a case of a thoracic intramedullary haemorrhage in a 61 year old man who had been commenced on warfarin 1 month previously, following aortic valve replacement. The literature is reviewed and reversal of warfarin effects, imaging and recommendations for treatment are discussed.

Topics: Hematoma; Humans; Male; Middle Aged; Spinal Cord Diseases; Thoracic Vertebrae; Tomography, X-Ray Computed; Warfarin

Nontraumatic spinal intradural extramedullary hematomas are extremely rare. When they occur, they can rapidly lead to spinal cord or cauda equina compression and have devastating consequences.. The aim here was to report a case of this rare phenomenon and discuss the etiology, imaging, management, and outcome of intradural hematomas.. We describe the case of a 76-year-old man on warfarin therapy who presented with severe lower back pain and flaccid paraparesis. Blood tests revealed an international normalized ratio of 6.0. A magnetic resonance imaging result suggested an intradural hematoma extending from L1 to L4 and compressing the spinal cord and cauda equina. Emergency surgical decompression revealed an extensive intradural extramedullary hematoma, which was evacuated. The patient showed only minor neurologic improvement 6 months postoperatively.. Coagulopathy-induced spinal hemorrhage should be included in the differential diagnosis for patients presenting with signs of acute spinal cord compression.

Topics: Aged; Anticoagulants; Decompression, Surgical; Dura Mater; Hematoma; Humans; Male; Spinal Cord Diseases; Warfarin

We report a 47-year-old woman with relapsed delayed radiation myelopathy (DRM), occurring 5 years and 10 years after radiation therapy for nasopharyngeal carcinoma at 37 years old. Sensations of pain and temperature had been disturbed in the right leg since 42 years old. MRI showed Gadolinium-enhanced lesion as a ring-like-enhancement of the spinal cord at C1-2 on T1-weighted image (T1WI), with high signal area and swelling of the spinal cord at the upper C1 to C6 areas on T2-weighted image. We diagnosed her as having DRM after considering the differential diagnosis, e.g., multiple sclerosis, spinal tumor and other neurological diseases. Her sensory symptoms quickly improved following therapy with prednisolone and warfarin. Although she remained healthy for a few years, dysesthesia of the neck on the right side appeared 5 years later after the first clinical occurrence. At this time, MRI demonstrated Gadolinium-enhanced lesion as a ring-like enhancement of the spinal cord at C2 on T1WI. but the area also differed from that of previous lesion; a high signal area and swelling of the spinal cord was also seen on FLAIR image of the medulla and upper C1 to C6. For recurrence of DRM, we administered prednisolone and warfarin. Thereafter, the patient recovered and the spinal cord lesion on MRI decreased markedly. The clinical course demonstrated that administration of prednisolone and warfarin might be effective for relapsed DRM.

Topics: Drug Therapy, Combination; Female; Humans; Magnetic Resonance Imaging; Methylprednisolone; Middle Aged; Prednisolone; Pulse Therapy, Drug; Radiation Injuries; Radiotherapy; Recurrence; Remission Induction; Spinal Cord; Spinal Cord Diseases; Time Factors; Treatment Outcome; Warfarin

Topics: Aged; Anticoagulants; Hemorrhage; Humans; Male; Quadriplegia; Spinal Cord Diseases; Warfarin

This is the first reported case in the emergency medicine literature of a drug interaction between warfarin and fluconazole. We present a case of spinal epidural haematoma and summarize four other case reports reported elsewhere from 1988 to 1996. We admonish emergency physicians to be aware of this dangerous drug combination. Warfarin and fluconazole are frequently encountered drugs in the emergency department and thus any interaction between these drugs is of considerable importance.

Topics: Adult; Aged; Anticoagulants; Antifungal Agents; Drug Interactions; Female; Fluconazole; Hematoma, Epidural, Cranial; Humans; Male; Spinal Cord Diseases; Warfarin

We describe two patients with established antiphospholipid syndrome, who during periods of subtherapeutic anticoagulation, developed acute optic neuropathy and transverse myelopathy. Treatment with optimal anticoagulation and high dose glucocorticoids was followed by resolution of the neurologic deficits.

Topics: Acute Disease; Adult; Anticoagulants; Antiphospholipid Syndrome; Female; Glucocorticoids; Humans; Magnetic Resonance Imaging; Optic Nerve Diseases; Sjogren's Syndrome; Spinal Cord Diseases; Warfarin

We present an infant who was exposed to warfarin throughout pregnancy and has warfarin embryopathy. When the child was examined radiologically at 20 months areas of calcification were visible in the septal and alar cartilages of the small external part of the nose. The location of this ectopic calcification is consistent with that seen in an animal model of the warfarin embryopathy. It supports the hypothesis that warfarin interferes with the prenatal growth of the cartilaginous nasal septum by inhibiting the normal formation of a vitamin K-dependent protein that prevents calcification of cartilage. The child also had severe abnormalities of the cervical vertebrae and secondary damage to the spinal cord. Cervical vertebral anomalies are a relatively common finding in the warfarin embryopathy and in the related Binder syndrome.

Topics: Adolescent; Antithrombin III Deficiency; Calcinosis; Cervical Vertebrae; Female; Humans; Infant; Male; Middle Aged; Nasal Septum; Pregnancy; Prenatal Exposure Delayed Effects; Radiography; Spinal Cord Diseases; Warfarin

When radiation is used to treat nervous system cancer, exposure of adjacent normal nervous system tissue is unavoidable, and radiation-induced injury may occur. Acute injury is usually mild and transient, but late forms of radiation-induced nervous system injury are usually progressive and debilitating. Treatment with corticosteroids, surgery, and antioxidants is often ineffective. We treated 11 patients with late radiation-induced nervous system injuries (eight with cerebral radionecrosis, one with a myelopathy, and two with plexopathies, all unresponsive to dexamethasone and prednisone) with full anticoagulation. Some recovery of function occurred in five of the eight patients with cerebral radionecrosis, and all the patients with myelopathy or plexopathy. Anticoagulation was continued for 3 to 6 months. In one patient with cerebral radionecrosis, symptoms recurred after discontinuation of anticoagulation and disappeared again after reinstitution of treatment. We hypothesize that anticoagulation may arrest and reverse small-vessel endothelial injury--the fundamental lesion of radiation necrosis--and produce clinical improvement in some patients.

Topics: Adult; Aged; Brain; Brain Neoplasms; Female; Glioblastoma; Heparin; Humans; Male; Middle Aged; Necrosis; Radiation Injuries; Spinal Cord Diseases; Warfarin

The relative safety of epidural catheter placement with subsequent heparinization has been well documented. However, what is the risk of neurologic sequelae in such patients who receive warfarin perioperatively? This study retrospectively evaluates the risk of spinal hematoma in patients receiving postoperative epidural analgesia while receiving low-dose warfarin after total knee replacement. All patients received low-dose warfarin to prolong the prothrombin time (PT) to 15.0-17.3 s (normal 10.9-12.8 s). There were 192 epidural catheters placed in 188 patients. All catheters were advanced through an 18-gauge needle. In 13 instances, blood was noted during needle and/or catheter placement. In addition to warfarin, 36 patients with indwelling catheters received nonsteroidal antiinflammatory drugs (NSAIDs). Epidural catheters were left indwelling 37.5 +/- 15 h (range 13-96 h). The mean PT was not increased beyond the normal range until the third postoperative day and did not reach 15 s until the seventh postoperative day. Cumulative warfarin dose at that time was 20.0 +/- 7.6 mg. Mean PT at the time of epidural catheter removal was 13.4 +/- 2 s. There were no signs of spinal hematoma. Although epidural catheter placement and subsequent anticoagulation with warfarin appears relatively safe, there is a large variability in patient response to warfarin; therefore, coagulation status should be monitored to avoid excessive prolongation of the PT, and the patient should be watched closely for evidence of spinal hematoma.

Topics: Aged; Analgesia, Epidural; Catheters, Indwelling; Female; Hematoma; Humans; Knee Prosthesis; Male; Postoperative Period; Retrospective Studies; Spinal Cord Diseases; Thrombophlebitis; Warfarin

Topics: Aged; Aged, 80 and over; Cervical Vertebrae; Combined Modality Therapy; Dexamethasone; Hematoma; Hemiplegia; Hemorrhage; Humans; Laminectomy; Male; Plasma; Spinal Cord; Spinal Cord Compression; Spinal Cord Diseases; Vitamin K; 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

The authors present the case of a 60-year old man with a spontaneous spinal intradural hematoma in the thoracic and lumbar region, which was caused by anticoagulant therapy and led to a severe progressive transverse lesion. After substitution of coagulation factors, a small catheter was inserted into the subarachnoid space via a lumbar puncture. By alternating irrigation and suction removal of the blood clot, restoration of the cerebrospinal fluid passage was possible along with a marked improvement in the neurological deficits. At 8 months' follow-up, the patient had completely recovered from the severe paraparesis and bladder dysfunction.

Topics: Catheterization; Drainage; Hematoma; Humans; Male; Middle Aged; Spinal Cord Diseases; Warfarin

The overall incidence of pulmonary embolism (PE) among neurosurgical in-patients, whose ages ranged from 23 to 80, was 0.7%. Our report here is based on five cases of patients with PE. Four of these five patients were over 50 years of age. They had been admitted because of such reasons as brain tumor, spinal cord injury, intracerebral hematoma, and venous sinus thrombosis. Deep vein thrombosis (DVT) was seen in four but none were diagnosed before they had developed PE. Decreased level of consciousness and prolonged bed rest appeared to be common risk factors for PE. Mean duration between admission and onset of PE was 31 days. Although non-specific, tachycardia, tachypnea and hypoxemia were the most common signs and symptoms. As a definitive diagnostic procedure, pulmonary angiography was performed in most of cases. One patient required surgical embolectomy and others were treated with anticoagulation or fibrinolytic agents. In order to prevent recurrent thromboembolic phenomena, ligation of the inferior vena cava was a useful mode of treatment when anticoagulation was not indicated. And this approach seemed to be valid in most neurosurgical patients. We conclude that PE and DVT were not uncommon complications among Japanese neurosurgical patients and they can be treated successfully in collaboration with a cardiovascular surgeon if the diagnosis can be made correctly.

Topics: Adult; Aged; Brain Diseases; Female; Humans; Male; Middle Aged; Postoperative Complications; Pulmonary Embolism; Spinal Cord Diseases; Thrombolytic Therapy; Urokinase-Type Plasminogen Activator; Vena Cava, Inferior; Warfarin

An unusual case of hematomyelia during anticoagulant therapy is reported in a patient after cardiac surgery. A review of the pertinent literature is presented. After medical and surgical treatment, the transverse symptoms largely subsided with rehabilitation of the patient.

Topics: Hemorrhage; Humans; Male; Middle Aged; Spinal Cord Diseases; Warfarin

Haemorrhage is the most serious and common side-effect of warfarin therapy. Bleeding had commonly been observed in the gastrointestinal and genitourinary tracts as well as in the skin and subcutaneous tissue. Central nervous system bleeding has also been reported and has usually been associated with marked prolongation of the prothrombin time. Spinal cord haemorrhage has been infrequently observed. The patient reported here may represent a previously undescribed complication of herpes zoster infection with haemorrhage in the involved dorsal root ganglia. Possible mechanisms are discussed.

Topics: Aged; Female; Hemorrhage; Herpes Zoster; Humans; Pulmonary Embolism; Spinal Cord Diseases; Warfarin

Topics: Humans; Male; Middle Aged; Neurilemmoma; Spinal Cord Diseases; Spinal Cord Neoplasms; Subarachnoid Hemorrhage; Warfarin

Of 217 patients with clinical diagnosis of acute stroke 23% had nonischemic lesions diagnosed by computed tomography (CT) or lumbar puncture (LP). CT demonstrated all 37 cases of intracerebral hemorrhagic lesions; 9 were detected by LP. CT failed to demonstrate 8 of 17 cases of subarachnoid hemorrhage, but only 1 of these lacked headache or stiff neck. In 7 of 342 patients who were treated with anticoagulants after LP, spinal hematoma followed LP ( 5 with paraparesis). CT evaluation reduced the incidence of fatal cerebral hemorrhage during anticoagulant therapy of acute stroke. However, even if patients were evaluated with both CT and LP, the incidence of fatal cerebral hemorrhage resulting from intravenous anticoagulant therapy was 2.4%.

Topics: Anticoagulants; Cerebrovascular Disorders; Hematoma; Heparin; Humans; Ischemic Attack, Transient; Spinal Cord Diseases; Spinal Puncture; Tomography, X-Ray Computed; Warfarin