Rare pathology leading to a diagnostic challenge: A subarachnoid spinal hematoma after catheter cryoablation for atrial fibrillation

Catheter ablation for atrial fibrillation is associated with a low rate of complications, with few reports of intracranial hemorrhage in the literature. Additionally, subarachnoid hemorrhage with spinal hematoma is also an uncommon pathology with less than 200 total cases to date described. A 78-year-old female with hypertension and atrial fibrillation on warfarin presented for catheter cryoablation and experienced periprocedural hypertension. Subsequently, post-procedure, the patient developed severe back pain, nausea, vomiting, altered consciousness, and paraplegia. Imaging demonstrated subarachnoid hemorrhage with hematoma compressing cord at the T4/5 level and infarction inferior to this level. The rare nature as well as presentation of this pathology, in the setting of a safe procedure, emphasizes the importance to re-evaluate diagnostic plans when patient presentation is inconsistent with expected post procedural course.