Quentin Mathais1, Pierre Esnault2, Maximilien Cruc2, Cedric Bernard3, Bertrand Prunet2, Pierre Emmanuel Gaillard2. 1. Department of Anesthesiology and Intensive Care, Military Hospital Sainte Anne, Toulon, France. Electronic address: quentin.mathais@orange.fr. 2. Department of Anesthesiology and Intensive Care, Military Hospital Sainte Anne, Toulon, France. 3. Department of Neurosurgery, Military Hospital Sainte Anne, Toulon, France.
Abstract
BACKGROUND: While spontaneous spinal epidural hematomas are rare, 1 of the identified risk factors is vitamin K antagonist therapy. CASE DESCRIPTION: We present a case of a spontaneous spinal epidural hematoma occurring in a patient under treatment with dabigatran, a non-vitamin K oral anticoagulant. The initial hemiparesis symptom was misleading and was retrospectively identified as Brown-Séquard syndrome. Immediate dabigatran antagonism with idarucizumab followed by posterior cervical laminectomy permitted a complete neurologic recovery at day 4. CONCLUSIONS: This is the first description of a spontaneous spinal epidural hematoma under non-vitamin K antagonist oral anticoagulant therapy that has been successfully antagonized and emphasizes the importance of specific antidote development.
BACKGROUND: While spontaneous spinal epidural hematomas are rare, 1 of the identified risk factors is vitamin K antagonist therapy. CASE DESCRIPTION: We present a case of a spontaneous spinal epidural hematoma occurring in a patient under treatment with dabigatran, a non-vitamin K oral anticoagulant. The initial hemiparesis symptom was misleading and was retrospectively identified as Brown-Séquard syndrome. Immediate dabigatran antagonism with idarucizumab followed by posterior cervical laminectomy permitted a complete neurologic recovery at day 4. CONCLUSIONS: This is the first description of a spontaneous spinal epidural hematoma under non-vitamin K antagonist oral anticoagulant therapy that has been successfully antagonized and emphasizes the importance of specific antidote development.