Extensive spontaneous spinal epidural haematoma: when 'treatment turned to tragedy'

A 30-year-old woman presented with acute onset of severe low back pain associated with weakness of both the lower limbs and retention of urine. She was a known case of rheumatic heart disease, mitral regurgitation and atrial fibrillation on anticoagulation with warfarin. Her weakness had ascended rapidly to the trunk and upper limbs. Examination revealed flaccid paralysis with bilateral extensor plantar response. Acute cord compression was suspected and MRI of the spine was performed, which revealed acute epidural haematoma extending from C6 to T10 (figure 1). Her international normalised ratio was 4.5. Emergency neurosurgical intervention was planned. Coagulopathy was corrected …