Spontaneous Spinal Intradural Haematoma in an Anticoagulated Woman

A 57-year-old woman, with a history of deep venous thrombosis and medicated with warfarin, presented at the hospital with acute back pain with paraplegia, headache, high blood pressure and vomiting. Imaging of the spine showed an acute intradural extramedullary haemorrhage with blood clot formation. The patient underwent surgery and received intensive post-surgical physiotherapy but remains paraplegic. Non-traumatic spinal intradural extramedullary haematoma (SIEH) is a rare neurological emergency that can result in spinal cord compression. Physicians should always consider this clinical entity as a differential diagnosis, especially in a patient presenting with acute back pain on anticoagulant therapy.

Learning points: Non-traumatic spinal intradural extramedullary haematoma is extremely rare.Acute cases can lead to spinal cord compression.Physicians should consider this clinical entity in anticoagulated patients presenting with acute onset of back or radicular pain followed by paraplegia, intestinal and bladder dysfunction.