Non-traumatic spontaneous spinal intradural extramedullary hemorrhage (SIEH) associated with rivaroxaban

Non-traumatic Spontaneous Intradural-Extramedullary Hematoma (SIEH) is a rare condition. Rivaroxaban is a Novel Oral Anticoagulant (NOAC), and there are few reports of rivaroxaban-associated SIEH. We report a 72-year-old male who had been taking rivaroxaban for his atrial fibrillation. He presented with sudden-onset paraplegia with a T7 sensory level and absent anal contraction. Magnetic resonance images of the spine revealed a long-segment T4-T8 ventral intradural extramedullary hematoma and T9-T10 dorsal intradural extramedullary hematoma both causing cord compression, associated with spinal cord oedema spanning from T8-T10 levels. To address the acute spinal cord compression, T4 to T10 laminectomy and evacuation of SIEH was performed for urgent spinal cord decompression. Sixteen months post-operation, he was able to ambulate independently albeit with residual bilateral lower limb weakness and numbness.