Delayed lumbar epidural haematoma in coincidence with anticoagulation, 3 months after spinal anaesthesia.

This case report deals with the very rare complication of an intraspinal haematoma: a 70 year old male underwent anticoagulation because of supraventricular dysrhythmias followed by two transient ischaemic attacks. He accidentally received an intramuscular injection for tetanus prophylaxis and developed a deep intramuscular haematoma, which was operated upon, after normalisation of coagulation parameters, under spinal anaesthesia. No primary complication was noted. Heparin therapy was started perioperatively, on the day of the operation. Sixteen days postoperatively, the patient resumed oral anticoagulation; 3 months later he developed a progressive cauda-equina-syndrome due to an epidural haematoma at the level of L2 to L4. This could be diagnosed by magnetic resonance imaging, but not by computed tomography. Acute surgical decompression was performed. The haematoma showed various ages as suspected by the intraoperative morphology and proven by histological examination. The neurological findings improved, and 6 months after rehabilitation only slight neurological deficits remained. Hypertension, anticoagulants, and spinal anaesthesia are discussed as risk factors for this complication.