Case Report

Massive Acute Spinal Subdural Hematoma Causing Sudden Onset Paraplegia in a Patient on Anticoagulation

Table 2

Characteristics of patients in the literature review.

Author and yearAge (years)SexLocationPresenting symptomsAnticoagulant/antiplateletRisk factorsSAHTreatmentOutcome

Miller 200467MT11-S1Progressive loss of sensation, bilateral leg weakness, back pain, urinary retentionWarfarinAtrial fibrillationNoneT10-L2 laminectomyNo recovery
Cha 200572FT3-T6Bilateral lower extremity paraplegia, sensory loss, urinary retention, back painLMWH, ASALaryngeal cancer, NSTEMINoneT3-T5 laminectomyMinimal recovery
Chau 200852MC7-L1Bilateral lower limb weakness, decreased lower extremity sensation, bowel and bladder dysfunctionLMWHSalmonella typhi, reactive arthritis, type II diabetesNoneT11-T12 laminectomyPartial recovery
Badge 200978FT3-T12Nausea, giddiness, headache, back pain, progressive L lower extremity weakness and ataxiaWarfarinAtrial fibrillationNoneT5 laminectomyImproved
Mete 201042MT6-L5Sudden headache and backache, agitation, paraparesis, meningismusWarfarinCardiac pacemaker, h/o cardiac bypassYesConservativeDeath (cardiac arrest)
Payer 201059MT2-T9Left-dominant paraparesis below T8, weakness, sphincter dysfunctionASA, clopidogrelCardiac stentingNoneConservativeFull strength recovery at 1 year, improvement in ataxia, paresthesia, urge incontinence
Wang 201267FL4-S1Back pain, bilateral radiating leg pain, bifrontotemporal headache, bilateral lower extremity weakness and numbnessASA, clopidogrelAtrial fibrillation, concomitant SDHNoneConservative (SSDH), burr hole craniotomy (SDH)Full recovery at 1 year
Bruce-Brand 201376ML1-L4Sudden onset severe low back pain, lower extremity weaknessWarfarinAtrial fibrillation, type II diabetes, HTN, dyslipidemiaNoneT12-L4 laminectomyPartial recovery at 6 months
Castillo 201569MT3-conusBack pain, bilateral lower extremity paraplegia, bowel and bladder dysfunctionRivaroxabanAtrial fibrillationNoneCervical and lumbar drainsNo recovery at 6 months
Dargazanli 201572MT6-T8Interscapular back pain, rapidly progressive bilateral lower extremity paraplegia, decreased lower extremity sensation to pain and temperature L > RRivaroxabanAtrial fibrillationNoneT6-T8 laminectomyNo improvement at 6 months
Frioui 201565FT12-L1Back pain, paraparesis, urinary retentionUnclear anticoagulantAtrial fibrillation, HTNNoneConservativeNeurological recovery observed at 24 h. Persistent urinary retention at 1 year
Jung 201553FC7-T6Sudden onset headache, nausea, vomiting, meningismus, bilateral lower extremity sensory loss and weakness, back painWarfarinAortic valve replacementYesC7-T6 laminectomyImprovement in anal tone and bladder function
Zaarour 201558MC7-T2Interscapular back pain, progressive bilateral lower extremity weakness and numbnessRivaroxabanAtrial fibrillation, type II diabetes, HTN, dyslipidemia, recent THA with spinal anesthesiaNoneInitially conservative, C7 corpectomy at HD4Improved
Siasios 201638FDiffuseSevere neck and back painWarfarinRecent C-section, PENoneConservativeFull recovery at discharge
Wolfe 201767MCervicothoracicLeft lower extremity weakness, urinary retentionDabigatranAtrial fibrillation, endocarditis, PCKD s/p transplant, BPH, OSA, melanomaYesConservativeFull recovery in 2 days
Akiyama 201771MT7-S12 weeks history bilateral lower leg pain, dysesthesia, paraparesis, urinary disturbance, and feverTiclodipineL cerebral infarct, unruptured L MCA aneurysmsNoneL3-L4 laminectomyImproved
Bunevicius 201768MT2-T6Left-sided chest and back pain, L leg weakness, and R leg numbnessWarfarinAtrial fibrillationNoneT3-T6 hemilaminectomyPartial improvement
Bang 2018Middle agedFThoracolumbarLower extremity weakness after assaultRivaroxabanAtrial flutterNoneLaminectomyNo improvement
Colell 201875FDiffuseBilateral lower extremity weakness L > R, decreased sensationApixabanAtrial fibrillation, HTNNoneLaminectomyImproved at 6 months
Girithari 201857FT4-T8Back pain, headache, vomiting, bilateral lower extremity weakness, urinary retentionWarfarinDVTNoneLaminectomyNo improvement at 6 months
Mchaourab 201868MT1-T5Back pain, urinary retention, headache, neck stiffness, vomiting, bilateral limb weakness, and ataxiaApixabanAtrial fibrillationPossibleConservativePartial improvement
Arain 201980FT4-T9Bilateral lower extremity paraplegia, incontinenceWarfarinAtrial fibrillationNoneT3-T11 laminectomyPartial improvement
Ardebol 201967FT4-T7Back pain, progressive bilateral lower extremity paraplegia, bowel and bladder dysfunctionApixabanAtrial fibrillationNoneT4-T7 laminectomyFull recovery at 1 year
Weiner 201942FL1-S1Vaginal pain, back pain radiating down the right leg, left leg weakness, frontal headacheWarfarin, ASARheumatic heart disease, mechanical mitral valve, CVA, concomitant SDH, concomitant arachnoiditisYesCraniotomy for SDH, conservative for SSDHFull recovery at 1 month