Multiple non-contiguous anticoagulation-related spontaneous acute spinal intradural extramedullary hemorrhages

BACKGROUND: Spinal intradural extramedullary hemorrhage is a rare and important pathology that may precipitate acute compressive myelopathy. It is most commonly associated with spinal trauma, neoplasia, vasculopathy, and iatrogenesis. In rare circumstances, it occurs spontaneously secondary to anticoagulant and antiplatelet medications without an underlying structural lesion. In these instances, it may be related to vasculopathy and/ or cardiovascular disease risk factors. We highlight the salient clinical and radiological features of this pathology, discuss putative mechanisms of its pathogenesis, and describe surgical considerations related to its management. CASE DESCRIPTION: This report describes an elderly gentleman who presented with two discrete spinal hemorrhages associated with separate foci of bleeding, in the context of therapeutic anticoagulation, on a background of significant structural and functional cardiovascular disease with risk factors. CONCLUSION: Our report is novel in that there are no other cases, to the best of our knowledge, of multiple non-contiguous anticoagulation-related spontaneous acute spinal intradural extramedullary hemorrhages in the medical literature. This article is written with the purpose of assisting clinicians to recognize and expedite treatment of this rare pathology. Prompt diagnosis followed by urgent decompressive surgery provides the best functional outcomes.