Document Detail

Intraspinal hemorrhage complicating oral anticoagulant therapy: an unusual case of cervical hematomyelia and a review of the literature.
MedLine Citation:
PMID:  10647763     Owner:  NLM     Status:  MEDLINE    
Intraspinal hemorrhage is a rare but dangerous complication of anticoagulant therapy. It must be suspected in any patient taking anticoagulant agents who complains of local or referred spinal pain associated with limb weakness, sensory deficits, or urinary retention. We describe a patient with hematomyelia, review the literature on hematomyelia and other intraspinal hemorrhage syndromes, and summarize intraspinal hemorrhage associated with oral anticoagulant therapy. The patient (a 62-year-old man) resembled previously described patients with hematomyelia in age and sex. However, he was unusual in having cervical rather than thoracic localization. As with intracranial bleeding, the incidence of intraspinal hemorrhage associated with anticoagulant therapy might be minimized by close monitoring and tight control of the intensity of anticoagulation. However, it is noteworthy that many of the reported cases were anticoagulated in the therapeutic range. If intraspinal hemorrhage is suspected, anticoagulation must be reversed immediately. Emergency laminectomy and decompression of the spinal cord appear mandatory if permanent neurologic sequelae are to be minimized. A high index of suspicion, prompt recognition, and immediate intervention are essential to prevent major morbidity and mortality from intraspinal hemorrhage.
V A Pullarkat; T Kalapura; M Pincus; R Baskharoun
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Archives of internal medicine     Volume:  160     ISSN:  0003-9926     ISO Abbreviation:  Arch. Intern. Med.     Publication Date:  2000 Jan 
Date Detail:
Created Date:  2000-02-10     Completed Date:  2000-02-10     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  0372440     Medline TA:  Arch Intern Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  237-40     Citation Subset:  AIM; IM    
Department of Medicine, New York Methodist Hospital, Brooklyn, USA.
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MeSH Terms
Administration, Oral
Anticoagulants / administration & dosage,  adverse effects*
Diagnosis, Differential
Hematoma, Epidural, Cranial / chemically induced,  diagnosis,  surgery
Hematoma, Subdural / chemically induced,  diagnosis,  surgery
Hemorrhage / chemically induced*,  diagnosis,  surgery
Magnetic Resonance Imaging
Middle Aged
Spinal Cord Vascular Diseases / chemically induced*,  diagnosis,  surgery
Thromboembolism / drug therapy
Warfarin / administration & dosage,  adverse effects*
Reg. No./Substance:
0/Anticoagulants; 81-81-2/Warfarin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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