Spontaneous cervical epidural hematoma associated with oral anticoagulant therapy

A 54-year-old woman who was on anticoagulant treatment with acenocoumarol f or a mitral prothesis developed a cervical spinal epidural hematoma, probab ly triggered by coughing fits together with supratherapeutic anticoagulatio n. Because of the subacute evolution of the hematoma, it was not diagnosed until the patient was admitted to the hospital with profuse hemorrhages. Gi ven the subacute nature of the hematoma, along with the favorable evolution , conservative treatment with dexamethasone was decided upon, and it was re solved with almost no sequelae. This unusual clinical entity definitely sho uld be suspected in patients on anticoagulants who complain of severe local ized neck pain, most often with radicular irradiation.