Spontaneous Cervical Spinal Epidural Hematoma Associated with Dabigatran.

Abstract

While spontaneous spinal epidural hematomas are rare, 1 of the identified risk factors is vitamin K antagonist therapy. 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. 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.