Spontaneous chronic epidural hematoma in the lumbar spine associated with Warfarin intake: a case report

INTRODUCTION: Spontaneous spinal epidural hematomas are rare. However, in patients on anticoagulant treatment the risk may increase. Symptomatically patients may present with radiculopathy and even progressive neurological deficits. CASE DESCRIPTION: We present a case of a warfarin treated patient with left L5 radiculopathy. MRI was evaluated as showing a lumbar disc prolapse or synovial cyst at L4–L5 level. The patient was operated and an organized material was removed and analysed as a hematoma. No prolapsed disc or synovial cyst was found. The patient was neurologically restored following the operation. DISCUSSION AND EVALUATION: This case illustrates how spontaneous epidural spinal hematomas can present with symptoms of radiculopathy and radiologically be misinterpreted as a protruding disc or cyst. CONCLUSION: Warfarin treated patients may have an increased risk of spontaneous spinal epidural hematomas.