title: Atypical Presentation of an Epidural Hematoma in a Patient Receiving Rivaroxaban After Total Hip Arthroplasty.
abstract: The authors report a case of a 69-year-old woman who presented with a spontaneous spinal epidural hematoma (SSEH) 10 days after a total hip arthroplasty. The patient had been receiving 10 mg/d of rivaroxaban for 5 days for venous thromboembolism prophylaxis. She had a sudden onset of severe neck pain, followed by quadriplegia below C4. A dorsal SSEH was revealed by computed tomography. While preparing for the emergency evacuation of the SSEH, the neurological symptoms resolved spontaneously in 4 hours. The 1-month follow-up magnetic resonance imaging confirmed that the SSEH had completely resolved. The pathogenesis of SSEH is unclear, but anticoagulant therapy is a known risk factor. It is a relatively rare disorder. Only 1 case of SSEH has been reported, and that patient was receiving a nonsteroidal anti-inflammatory drug besides rivaroxaban, which is another known risk factor for bleeding disorders. [Orthopedics. 2016; 39(3):e558-e560.].
authors.forename: Omer
authors.initials: O
authors.lastname: Ozel
authors.forename: Emre
authors.initials: E
authors.lastname: Demircay
authors.forename: Atilla
authors.initials: A
authors.lastname: Kircelli
authors.forename: Tufan
authors.initials: T
authors.lastname: Cansever
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D005260:Female; D046748:Hematoma, Epidural, Spinal / Q000139:chemically induced / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D019547:Neck Pain / Q000209:etiology; D035583:Rare Diseases / Q000601:surgery; D012307:Risk Factors; D000069552:Rivaroxaban / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D054556:Venous Thromboembolism / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D000069552:Rivaroxaban