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KMID : 1011920140150040045
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International Journal of Arrhythmia
2014 Volume.15 No. 4 p.45 ~ p.48
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Warfarin-associated Extensive Spontaneous Spinal Epidural Hematoma Mimicking Stroke
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Lee Ki-Hong
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Abstract
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Clinicians usually suspect acute stroke when patients with atrial fibrillation (AF) present with neurologic symptoms. I report such a patient on warfarin therapy complaining of acute-onset right hemiplegia, which was diagnosed as extensive spinal epidural hematoma rather than stroke. International normalized ratio (INR) was within therapeutic range, with no recent dosage change. Brain MRI revealed no acute stroke. Further neurologic examination demonstrated reduced pain and temperature sensations below T2 level. Subsequently, cervical MRI was performed and revealed a massive spinal epidural hematoma in the posterior and right posterolateral regions of the spinal canal from C1 to T2. The patient underwent emergency right cervical decompressive laminectomy 24 hours after symptom onset. After 2 weeks of rehabilitation, the patient made a near-complete recovery of motor and sensory function. Spinal epidural hematoma should be the first differential diagnosis considered during acute stroke work-up in patients on warfarin medication.
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KEYWORD
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spinal epidural hematoma, warfarin
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