A Case Report: The Challenging Diagnosis of Spontaneous Cervical Epidural Hematoma

Abstract

Introduction: We present the case of a patient with a spontaneous cervical epidural hematoma that presented with neck pain and mild, left arm parasthesia. Case Report: A 59-year old man presented with sudden onset of severe neck pain, without history of injury or trauma. The patient also complained of associated left arm parasthesias that progressed to left arm and leg weakness while in the emergency department. Multiple diagnoses were considered and worked up; eventually the correct diagnosis was made with magnetic resonance imaging of the cervical spine. Conclusion: Spontaneous cervical epidural hematoma typically presents with neck pain, and variable neurologic complaints. This case illustrates the challenge in making this uncommon but serious diagnosis.

An unusual case of ventral spontaneous thoracic epidural hematoma

“…Misdiagnosis of SSEH is common due to its low incidence. 18 Spinal MRI is the first choice for SSEH diagnosis and also allows evaluation of spinal cord compression. 19 , 20 SSEH yields an isointense signal change on T1‐weighted images within the first 24 h after bleeding and a hyperintense signal change on T2‐weighted images after 24 h. 21 T2 hyperintensity in the spinal cord within 24 h signals poor clinical outcomes, because it identifies myelomalacia and radiographic spinal cord injury.…”

“…Misdiagnosis of SSEH is common due to its low incidence 18 . Spinal MRI is the first choice for SSEH diagnosis and also allows evaluation of spinal cord compression 19,20 .…”

“…10 Misdiagnosis of SSEH is common due to its low incidence. 18 Spinal MRI is the first choice for SSEH F I G U R E 6 After decompression with hematoma evacuation and laminectomy, thoracic spinal MRI at T4-5 level with sagittal T2-weighted sequence showed a complete clearance of hematoma with normal ventral and dorsal epidural space and resolution of spinal cord compression.…”

Spontaneous cervical epidural hematoma: Insight into this occurrence with case examples

“…Unfortunately, SSEH is a rare condition that is commonly misdiagnosed. [ 3 ] We propose a standard approach to evaluating patients with suspected SSEH including an initial clinical evaluation and confirmatory MR imaging studies. All patients should first be evaluated with a thorough history and physical focused on assessing for neurologic deficits.…”