Spontaneous intramedullary spinal cord haemorrhage due to anticoagulation therapy
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Medical University of Lublin, Poland
Corresponding author
Maciej Szmygin   

Medical University of Lublin
J Pre Clin Clin Res. 2019;13(4):179-180
Anticoagulants are used mainly in the prevention of venous thromboembolism. The frequency of haemorrhagic complications is correlated with patients’ age and level of International Normalized Ratio (INR). Spontaneous intramedullary spinal cord haemorrhage due to anticoagulation therapy is an extremely rare occurrence. A 62-year old male was admitted to hospital with acute abdominal pain and paraplegia. Because of persistent atrial fibrillation and previous history of ischaemic stroke, on admission the patient was treated with anticoagulant, INR - 15. MRI revealed an abnormal fusiform hyperintesity area in the spinal cord. ‘Haemo’ sequence confirmed the presence of hemosiderin deposits at the level of Th5 - Th7. Anticoagulation therapy might be a cause of spontaneous intramedullary spinal cord haemorrhage. Maintaining high levels of clinical suspicion and utilizing MRI with additional ‘haemo’ option may help in making the right diagnosis.

Alquwaizani M, Buckley L, Adams C, Fanikos J. Anticoagulants: A Review of the Pharmacology, Dosing, and Complications. Curr Emerg Hosp Med Rep.
Navgren M, Forsblad J, Wieloch M. Bleeding complications related to warfarin treatment: a descriptive register study from the anticoagulation clinic at Helsingborg Hospital. J Thrombosis Thrombolysis. 2013; 38(1): 98–104.
Brandt M. Spontaneous intramedullary haematoma as a complication of anticoagulant therapy. Acta Neurochir (Wien) 1980; 52: 73–77.
Leep Hunderfund AN, Wijdicks EFM. Intramedullary spinal cord hemorrhage (hematomyelia). Rev Neurol Dis. 2009;6:E54–61.
Karavelis A, Foroglou G, Petsanas A, et al. Spinal cord dysfunction caused by non- traumatic hematomyelia. Spinal Cord. 1996; 34: 268–71.
Zeidman SM, Olivi A. Cervical intramedullary hemorrhage as a result of anticoagulant therapy. J Spinal Disord. 1993; 6: 456–7.
Famularo G, Sajeva MR, Gasbarrone L. Warfarin-associated Hematomyelia. Int Med. 2014; 53(6): 623–626. doi:10.2169/internalmedicine.53.1544.
Lu DC, Lawton MT. Clinical presentation and surgical management of intramedullary spinal cord cavernous malformations. Neurosurg Focus. 2010; 29: E12.
Chao C-H, Tsai T-H, Huang T-Y, et al. Idiopathic spontaneous intraspinal intramedullary hemorrhage: a report of two cases and literature review. Clin Neurol Neurosurg. 2013; 115: 1134–6.
Kharkar S, Shuck J, Conway J, et al. The natural history of conservatively managed symptomatic intramedullary spinal cord cavernomas. Neurosurgery 2007; 60: 865–72.
Oh HM, Nam TW, Kim JH, Jung TD. Effects of rehabilitation on spontaneous intramedullary spinal cord hemorrhage (hematomyelia) patient without surgery A case report. Medicine (Baltimore). 2018 Nov; 97(48): e13414.
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