Spontaneous Cervical Epidural Hematoma as a Complication of Oral Anticoagulant Therapy

Abstract

Spontaneous cervical epidural hematomas, an infrequent cause of neck pain, are more common in patients with vascular malformations or coagulation disorders. Treatment usually involves emergent surgical decompression. A 65-year-old woman on warfarin because of right lower extremity deep venous thrombosis and history of myelofibrosis, presented to the emergency department with neck pain, weakness and numbness of her right arm. Cervical spine films were negative. MRI of the spine showed a hyperintense lesion on T1 weighted images, extending from C3-T1, consistent with an epidural hematoma. INR was 1.8. Her neck pain, weakness and numbness improved slowly over two weeks time. She recovered without surgery.