Spontaneous Spinal Intradural Haematoma in an Anticoagulated Woman.

A 57-year-old woman, with a history of deep venous thrombosis and medicated with warfarin, presented at the hospital with acute back pain with paraplegia, headache, high blood pressure and vomiting. Imaging of the spine showed an acute intradural extramedullary haemorrhage with blood clot formation. The patient underwent surgery and received intensive post-surgical physiotherapy but remains paraplegic. Non-traumatic spinal intradural extramedullary haematoma (SIEH) is a rare neurological emergency that can result in spinal cord compression. Physicians should always consider this clinical entity as a differential diagnosis, especially in a patient presenting with acute back pain on anticoagulant therapy. LEARNING POINTS: Non-traumatic spinal intradural extramedullary haematoma is extremely rare.Acute cases can lead to spinal cord compression.Physicians should consider this clinical entity in anticoagulated patients presenting with acute onset of back or radicular pain followed by paraplegia, intestinal and bladder dysfunction.

Non-traumatic Hematomyelia: A Rare Finding in Clinical Practice.

Non-traumatic haematomyelia is a rare finding of acute onset, which in most cases is the result of arteriovenous malformations (AVM), tumours, coagulation disorders or autoimmune conditions, but may also be secondary to treatment with anticoagulants and radiotherapy. We present the case of a 58-year-old woman with sudden onset cervical pain, followed by asymmetric diminution of strength in the upper limbs with reduced pain sensitivity. The diagnosis of AVM at the C7 and D1 levels was made following cervico-dorsal magnetic resonance imaging and angiography. Treatment was embolization with immediate isolation of the AVM. LEARNING POINTS: Central nervous system lesions (including subarachnoid haemorrhage) can be located in the spine as well as the brain.Subarachnoid haemorrhage can be diagnosed through examination of the cerebrospinal fluid, especially when the CT scan is normal in patients with typical signs of this condition (acute neurological deficits with pain and signs of meningeal irritation like fever or neck rigidity).Non-traumatic haematomyelia is a rare finding.

The Hippocratic Splash.

Although the current medical literature is limited, hydropneumothorax was described as far back as the 5th century BC. It is characterized by the presence of air and fluid in the pleural cavity and is an infrequent finding. Causes include trauma, iatrogenesis following thoracentesis, the presence of gas-forming organisms, tuberculosis and malignancy. Diagnosis is based on clinical and radiological features. We report a case of hydropneumothorax and present radiological images showing the distinctive features of this entity. LEARNING POINTS: Hydropneumothorax is defined as the presence of air and fluid in the pleural cavity and is an infrequent finding.Clinical features may present as breathlessness and chest pains with decreased breath sounds, dullness in a straight line, shifting dullness, a succussion splash and a positive coin test on physical examination; supine radiography demonstrates a distinctive pleural line with increased density lateral in the pleural cavity.Hydropneumothorax is managed by chest tube insertion for intercostal drainage.