Acute Cervical Spontaneous Spinal Epidural Hematoma Presenting with Minimal Neurological Deficits: A Case Report

Huh, Jisoon; Kwak, Ho‐Young; Chung, Young-Sook; Park, Sun Kyung; Choi, Yun Suk

doi:10.5812/aapm.40067

Cited by 12 publications

(7 citation statements)

References 21 publications

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“…[ 12 , 21 ] Conservative management can also be considered in those SSEH patients with minimal neurological deficits or who have rapidly improving neurological function. [ 22 ] Delayed surgical decompression was performed in our patients, and her condition deteriorated due to hematoma expansion.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous spinal epidural hematoma mimicking transient ischemic attack

Rui

et al. 2017

Medicine

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Rationale:Spontaneous spinal epidural hematoma (SSEH) is a rare but highly disabling neurological emergency. The initial presentations are variable. Most patients of SSEH present with paraplegia or tetraplegia clinically, but recurrent hemiparesis with complete spontaneous recovery, mimicking transient ischemic attack (TIA), is a very rare initial presentation of SSEH.Patient concerns:A 71-year-old female presented to the emergency department with 2 episodes of transient right hemiparesis in 5 hours. Two days later, above symptom reappeared and progressed to quadriplegia, dyspnea, and uroschesis quickly. The neurological examination showed tetraplegia and hypalgesia below the C2 level, but neither facial palsy nor aphasia was found.Diagnosis:The patient was initially misdiagnosed as TIA and treated with antiplatelet therapy. But during the hospital day, the cervical magnetic resonance imaging showed a dorsal epidural hematoma extending from C2 to C6 level and she was diagnosed as SSEH.Interventions:She underwent surgical decompression and hematoma removal 1 week later.Outcomes:One week after operation, the sensory deficit above C6 level improved, but there was no improvement in her muscle strength and dyspnea. Unfortunately, she died 1 month later.Lessons:Our case highlights recurrent hemiparesis with complete spontaneous recovery mimicking TIA is a rare initial presentation of SSEH. It is important to perform careful clinical assessments and neuroimaging investigations for correct diagnosis. Neck pain and hemiparesis sparing cranial nerve are important signs for distinction of SSEH from acute ischemic cerebrovascular diseases.

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Section: Discussionmentioning

confidence: 99%

Spontaneous spinal epidural hematoma mimicking transient ischemic attack

Rui

et al. 2017

Medicine

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“…Spontaneous resolution of SEH usually occurs several hours to days after onset 23 . This has been hypothesized to be due to the spreading of the hematoma along the spinal epidural space though no conclusive evidence has been reached 24,25 .…”

Section: Discussionmentioning

confidence: 99%

Stroke-like manifestation of a spontaneous spinal epidural hematoma with spontaneous resolution: A case report

Bi¹,

Min

2022

Preprint

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Background This case reports presents the case of a man with no known coagulopathy or preceding trauma, who spontaneously developed a spinal epidural hematoma (SEH). This is an uncommon condition which can have variable presentations including hemiparesis mimicking stroke, resulting in the potential for misdiagnosis and inappropriate treatment. Case presentation A 28-year-old Chinese male with no past medical history presented with sudden onset neck pain associated with bilateral upper limbs and right lower limb subjective numbness but intact motor function. He was discharged after adequate pain relief but re-attended the emergency department with right hemiparesis. A magnetic resonance imaging of his spine revealed an acute cervical spinal epidural hematoma at C5 and C6. While admitted, he had spontaneous improvement of his neurological function and was eventually managed conservatively. Conclusions SEH, although uncommon, can be a mimic of stroke and it is important to avoid misdiagnosis as it is a time critical diagnosis, and administration of thrombolysis or antiplatelets can lead to unfavorable outcomes. Having a high clinical suspicion can help to guide us in the choice of imaging and interpretation of subtle signs to reach the correct diagnosis in a timely manner. Further research is required to better understand the factors that would favour a conservative approach as opposed to surgical treatment.

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“…10 Once the diagnosis of cervical SEH is made, surgical decompression such as early laminar decompression and hematoma evacuation is the current mainstay, 2,10,11 though some cases receiving conservative treatments also had favorable outcomes. 12 The prognosis of the disease depends on the preoperative neurological deficits and the time interval between the onset of symptoms and operation. 13 Thus, early recognition and thorough neurological examination are crucial and spontaneous SEH should always be taken into consideration in patients with ESRD and weakness.…”

Section: Discussionmentioning

confidence: 99%