Surgical Neurology International • 2021 • 12(256) | 1 is is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. ©2021 Published by Scientifc Scholar on behalf of Surgical Neurology International Case Report Spontaneous thoracolumbar epidural hematoma in an apixaban anticoagulated patient Andreas eofanopoulos 1 , Petros Zampakis 2 , Elefheria Antoniadou 3 , Dimitrios Papadakos 1 , Dionysia Fermeli 1 , Constantine Constantoyannis 1 , Lambros Messinis 4 , Vasileios Panagiotopoulos 5 Departments of 1 Neurosurgery, 2 Radiology and Interventional Neuroradiology, University of Patras, University Hospital of Patras, 3 Department of Rehabilitation, Rehabilitation Clinic, University of Patras, University Hospital of Patras, Departments of 4 Neurology and Psychiatry, Neuropsychology Section, 5 Neurosurgery and Endovascular Neurosurgery, University of Patras, University Hospital of Patras, Patras, Achaia, Greece. E-mail: *Andreas eofanopoulos - andreastheofano@gmail.com; Petros Zampakis - pzampakis@gmail.com; Elefheria Antoniadou - elefheria.antoniadou@ gmail.com; Dimitrios Papadakos - dimitriospapadakos@outlook.com; Dionysia Fermeli - deniafml@gmail.com; Constantine Constantoyannis - cconst@ upatras.gr; Lambros Messinis - lmessinis@upatras.gr; Vasileios Panagiotopoulos - panagiotopoulos2000@yahoo.com *Corresponding author: Andreas eofanopoulos, Department of Neurosurgery, University of Patras, University Hospital of Patras, Patras, Achaia, Greece. andreastheofano@gmail.com Received : 30 April 2021 Accepted : 19 May 2021 Published : 07 June 2021 DOI 10.25259/SNI_434_2021 Quick Response Code: INTRODUCTION Spontaneous spinal epidural hematoma (SSEH) is rare (afecting 0.1/100,000 persons/year) and can potentially result in life-altering neurological disability and/or mortality. [2,4] Based on numerous studies, patients on anticoagulation (i.e. warfarin or heparin) are susceptible to developing SSEH. [5] However, there are only scarce reports regarding the impact of newer oral anticoagulants (NOAC) on the incidence of SSEH. [1] Here, an 83-year-old female on apixaban developed a thoracolumbar SSEH (levels T10–L3). Following an urgent MRI, the patient underwent a T10–L3 laminectomy. Within 2 months postoperatively, her preoperative lower extremity paresis and urinary retention fully resolved. ABSTRACT Background: Spontaneous spinal epidural hematomas (SSEHs) are ofen attributed to anticoagulation. Although they are rare, they may contribute to signifcant morbidity and mortality. Case Description: An 83-year-old female with a history of atrial fbrillation 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 defcits 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 defcits. Keywords: Apixaban, Spontaneous spinal epidural hematoma, SSEH www.surgicalneurologyint.com Surgical Neurology International Editor-in-Chief: Nancy E. Epstein, MD, Clinical Professor of Neurological Surgery, School of Medicine, State U. of NY at Stony Brook. SNI: Spine Editor Nancy E. Epsteint, MD Clinical Professor of Neurological Surgery, School of Medicine, State U. of NY at Stony Brook Open Access