Spinal epidural haematoma in haemophilia A with inhibitors--efficacy of recombinant factor VIIa concentrate.

We report the case of a 21-year-old man with severe haemophilia A and factor VIII inhibitors who presented with an extensive spinal epidural haematoma (C2-T12), probably induced by sit-up exercises. The bleed was defined by magnetic resonance imaging of the cervical and thoracic spine and prompt treatment with recombinant factor VIIa concentrate led to complete resolution at 4 weeks. Neurological sequelae were averted and surgical decompression was not necessary. We discuss the difficulties in diagnosis and management of such a case.