Disclosures: Liridon Zendeli, MD: No financial relationships or conflicts of interest

Case Diagnosis: Spinal epidural hematoma (EDH) is a rare entity, especially in the context of fibrinolytic agents including tissue plasminogen activator (tPA), that causes a non-traumatic spinal cord injury (SCI) requiring neurosurgical intervention and interdisciplinary rehabilitation.

Case Description: Our patient is a 59-year-old male with history of recent Coronavirus Disease-2019 (COVID-19) pneumonia who presented to the hospital with chest pain and dyspnea following syncope. Diagnostic workup revealed a massive saddle pulmonary embolism for which he received intravenous tPA. The next day, he developed hemoptysis, hematuria, ascending weakness, urinary retention, bowel incontinence, and respiratory failure requiring intubation. Imaging of the spine revealed a dorsal spinal EDH extending from C2 through T11 vertebral levels, associated with significant anterior displacement of the spinal cord with signal changes at T10-T11. He received intravenous dexamethasone and underwent an emergent C2-T11 hemilaminectomy and EDH evacuation. Hospitalization was complicated by tracheobronchitis requiring tracheostomy and dysphagia requiring gastrostomy. On presentation to acute inpatient rehabilitation (AIR), the International Standards for Neurological Classification of Spinal Cord Injury exam was performed and was significant for C4 AIS A complete tetraplegia.

Setting: Acute inpatient rehabilitation.Assessment/

Results: At 1-month post-AIR admission, he progressed from total to maximal assistance for some activities of daily living and mobility. His respiratory insufficiency improved with aggressive pulmonary hygiene while working towards decannulation. Additionally, his dysphagia resolved with subsequent removal of gastrostomy. Although no emerging movement in his lower extremities was noted, he did have partial preservation of sensation down to T12 level.

Discussion: This case illustrates a unique association between an acute, non-traumatic SCI and the hypercoagulable state of COVID-19 precipitating a life-threatening pulmonary embolism which required use of intravenous fibrinolysis.

Conclusion: The purpose of this case study is to demonstrate the rare, but devastating complication of fibrinolysis in treatment of COVID-19 hypercoagulability resulting in a non-traumatic SCI, complete tetraplegia, due to spinal EDH.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/spinal-epidural-hematoma-with-cord-compression-a-case-report-of-non-traumatic-spinal-cord-injury-after-fibrinolysis-of-massive-pulmonary-embolism-due-to-covid-19-hypercoagulability/