SPONTANEOUS SPINAL EPIDURAL HEMATOMA IN A PATIENT WITH A MECHANICAL AORTIC-VALVE TAKING WARFARIN

A 59-year-old male with a mechanical aortic valve taking warfarin pres ented to hospital with Brown-Sequard syndrome caused by a spontaneous spinal epidural hematoma (SSEH) precipitated by a coughing fit. Guided by a literature review of the risks of administering or withholding a nticoagulation in this patient, doctors advised a regimen of warfarin to achieve an international normalized ratio of 1.5 to 2 and dipyridam ole (75 mg qid) to protect against thromboembolic complications while minimizing the risk of recurrent SSEH.