Spontaneous Spinal Epidural Hematoma due to Anticoagulant Therapy: A Case Report and Literature Review

Aims: We report a case of spontaneous spinal epidural hematoma (SSEH) that occurred in a patient on life-long warfarin following liver transplant due to decompensated liver failure secondary to primary Budd-Chiari syndrome. Patients and Methods: Our patient presented with acute central back pain with bilateral lower limb paralysis and incontinence with neurological level of T8 American Spinal Injury Association Impairment Scale (AIS) A. There were no history of fever, trauma or straining. MRI revealed a hyper-intense lesion at level of T8 till T10 and patient underwent an urgent laminectomy which revealed an epidural hematoma at that level. Result: Post-operatively, patient gradually improved with final neurology level at level of T9 AIS D prior to discharge. Conclusion: A prompt diagnosis and intervention are needed in cases of SSEH to achieve a favourable outcome.