Multilayer spinal hemorrhage in a patient on long-term warfarin: A case report.

BACKGROUND

Spinal cord hemorrhages are very rare conditions. It can be categorized into four types based on its anatomical location: epidural, subdural, subarachnoid, and intramedullary. The incidence of spinal hematomas remains undetermined due to limited data. Early detection and prompt management are critical for better outcomes in terms of morbidity and mortality.

CASE REPORT: A 65-year-old Southeast Asian female with a history of mechanical valve replacement and long-term warfarin use presented with progressive back pain following a mild back pain after riding a speedboat. She later developed sudden bilateral lower limb weakness and urinary retention. Magnetic resonance imaging (MRI) revealed multiple spinal cord hematomas: intramedullary from T4 to the conus medullaris, epidural from T8 to L1, and subdural from T2 to T7. She underwent T10-T12 laminectomy for epidural hematoma evacuation. Anticoagulation therapy with warfarin was resumed under close monitoring of international normalized ratio.

CONCLUSION

Spinal hemorrhage involving multiple spinal cord layer is a very rare condition. It should be considered in patients with acute back pain and neurological symptoms. MRI is the imaging modality of choice, with early decompression within 12 h of symptom onset improving outcomes. Prompt correction of coagulopathy is crucial to prevent hematoma expansion. Proper warfarin management is essential to prevent the recurrence of bleeding events while ensuring cardiovascular protection.