Background:
Spontaneous spinal epidural hematomas (SSEHs) are often attributed to anticoagulation. Although they are rare, they may contribute to significant morbidity and mortality.
Case description:
An 83-year-old female with a history of atrial fibrillation on apixaban, presented with 4 days of back pain, progressive lower extremity weakness and urinary retention. When the patient's MRI showed a dorsal thoracolumbar SSEH, the patient underwent a T10-L3 laminectomy for hematoma evacuation. Within 2 postoperative months, her neurological deficits fully resolved.
Conclusion:
Apixaban is associated with SSEH resulting in severe neurological morbidity and even mortality. Prompt MRI imaging followed by emergency surgical decompressive surgery may result in full resolution of neurological deficits.