Roçi E, Çibuku O, Mara E, Thimjo V, Vyshka G. Incomplete Brown-Séquard syndrome secondary to acenocoumarol-induced hematomyelia: A case report. World J Crit Care Med 2026; 15(3): 117716 [DOI: 10.5492/wjccm.117716]
Corresponding Author of This Article
Gentian Vyshka, MD, Department of Biomedical and Experimental, Faculty of Medicine, University of Medicine, Rr. Dibres 371, Tirana 1005, Albania. gentian.vyshka@umed.edu.al
Research Domain of This Article
Critical Care Medicine
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case-report
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Roçi E, Çibuku O, Mara E, Thimjo V, Vyshka G. Incomplete Brown-Séquard syndrome secondary to acenocoumarol-induced hematomyelia: A case report. World J Crit Care Med 2026; 15(3): 117716 [DOI: 10.5492/wjccm.117716]
Ermir Roçi, Oneda Çibuku, Emili Mara, Vasilika Thimjo, Division of Neurosciences, University Hospital Center Mother Theresa, Tirana 1005, Albania
Gentian Vyshka, Department of Biomedical and Experimental, Faculty of Medicine, University of Medicine, Tirana 1005, Albania
Author contributions: Roçi E, Çibuku O, Mara E and Thimjo V contributed to manuscript drafting, patient consulting, treatment and follow-up; Mara E and Vyshka G contributed to manuscript writing and revising; literature review; all authors have read and approved the final manuscript.
AI contribution statement: Authors have used the free online version of Grammarly for language corrections and polishing. The main text of the manuscript was created from the authors and was edited from a specialized English editing service (certificate provided). The paper is a case report, and no AI tool was used to design the structure of the manuscript. Images are authentic and were not enhanced or altered by AI or any other photo editing software.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Gentian Vyshka, MD, Department of Biomedical and Experimental, Faculty of Medicine, University of Medicine, Rr. Dibres 371, Tirana 1005, Albania. gentian.vyshka@umed.edu.al
Received: December 17, 2025 Revised: January 17, 2026 Accepted: February 13, 2026 Published online: September 9, 2026 Processing time: 256 Days and 13.1 Hours
Abstract
BACKGROUND
Intramedullary spinal cord hemorrhage, also known as hematomyelia, is an uncommon but clinically significant condition. It accounts for approximately 0.82% of all spinal hematomas, making it one of the least frequently encountered etiologies of acute myelopathy. Hematomyelia may result from a variety of causes, including vascular malformations (such as cavernomas or arteriovenous fistulas), bleeding diatheses, spinal cord tumors, trauma, or complications related to anticoagulation therapy.
CASE SUMMARY
Here, we describe a patient on acenocoumarol who developed incomplete Brown-Séquard syndrome secondary to spontaneous intramedullary hemorrhage. She presented to the emergency department with a one-week history of progressively worsening headache, neck pain, and left hemithoracic pain. Prompt magnetic resonance imaging allowed diagnosis, and conservative management led to neurological stabilization. Our case underscores the need for timely diagnostic imaging in patients taking anticoagulants who present with new neurological deficits. It also highlights the diagnostic challenges and therapeutic decisions associated with this rare complication.
CONCLUSION
In some cases, the cause of hematomyelia remains idiopathic. Vitamin K antagonists are widely used for the long-term prevention of thromboembolic events; hence, prompt diagnosis of potential complications is important.
Core Tip: Spontaneous intramedullary spinal cord hemorrhage is a rare but devastating complication of vitamin K antagonist therapy. This case demonstrates that even therapeutic international normalized ratio levels do not guarantee hemorrhagic safety. A 70-year-old woman on acenocoumarol developed an incomplete Brown-Séquard syndrome due to thoracic hematomyelia. Prompt magnetic resonance imaging allowed diagnosis, and conservative management led to neurological stabilization. Clinicians should maintain high suspicion for spinal hemorrhage in anticoagulated patients with acute myelopathy.
