Particularities of clinical onset and favorable evolution towards functional neurorehabilitation in a very large post-acenocoumarol overdose hematoma (C7-t10) —a case report

Abstract

Introduction: The incidence of spontaneous spinal epidural hematoma is relatively rare and it may cause a spinal cord injury possibly associated with related severe disabling conditions: sensory-motor impairments, back pain, neurogenic bladder and bowel. The MRI is the golden standard diagnostic examination in patients suspected of spinal epidural hematoma. Still, such a spontaneous condition can be, not-seldom, asymptomatic. Materials and methods: This paper presents the case of a 79-year-old male patient with permanent atrial fibrillation, treated with acenocoumarol, who was admitted, first in the General Surgery Clinic Division with rectal tenesmus and acute urinary retention and, subsequently developed a sudden onset of motor deficit, as presented in the body text. The patient was diagnosed with epidural hematoma (C7-T10) resulting in AIS/Frankel C paraplegia, with T10 neurological level. The positive and differential diagnoses concluded that the acenocoumarol overdose was the main etiopathogenic factor. Results: The patient—being promptly transferred to the Spinal Neurosurgical Clinic Division—received conservative treatment, followed by a neuro-muscular rehabilitation program achieved in our Neuro-Rehabilitation Clinic Division, with mainly favorable outcomes: at discharge he was able to walk independently on short distances. Conclusions: The clinical outcomes and quality of life of patients suffering from spinal epidural hematoma depend on the fast diagnosis and efficient acute neurosurgical/conservative treatment, followed by an appropriate rehabilitation program, including with medium and long term medical follow-up. This clinical case has received the Teaching Emergency Hospital “Bagdasar-Arseni” Bioethics Committee approval No. 27/1935-25.02.2021.