Delayed cervical epidural hematoma after intravenous thrombolysis for acute ischemic stroke: Case report and review of literature

Ghadirpour, Reza; Nasi, Davide; Benedetti, B.; Zedde, Marialuisa; Iaccarino, Corrado; Malferrari, Giovanni; Servadei, Franco

doi:10.1016/j.clineuro.2014.04.005

Cited by 3 publications

(5 citation statements)

References 9 publications

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“…Absent abnormality of cranial nerves was a differentiated point between SCEH and IS. However, in this review, mild dysarthria was seen in 6 patients [3-5, 13, 33, 37] and decreased sensation of the ipsilateral face was seen in 1 patient [38], which could easily mislead to diagnosis of stroke. Dysarthria of these patients was described as mild, slight, or even uncertain.…”

Section: Discussionmentioning

confidence: 89%

“…Several patients presented specific clinical presentations such as Brown-Séquard syndrome [4, 13] and Lhermitte’s sign [24], which strongly imply spinal cord injury [3, 4]. Two patients presented Horner syndrome [4, 13], but we need to carefully differentiate them from other diseases with Horner syndrome: (1) In SCEH patients, Horner syndrome was ipsilateral to the side of hemiparesis.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, thorough neurological examination and detailed history taking were crucial to differentiate SCEH from IS. Despite some case reports and several case summaries of small samples in the literature [3,[7][8][9], the analysis of clinical characteristics of large samples is lacking.…”

Section: Introductionmentioning

confidence: 99%

“…SCEH is a condition that requires a quick and accurate diagnosis and prompt surgical treatment [2]. However, SCEH patients misdiagnosed as IS might be erroneously treated with recombinant tissue plasminogen activator (rt-PA) if they are within the thrombolysis time window of 4.5 h or treated with antiplatelet/anticoagulation drugs if the time window is exceeded [3, 4]. Considering that these erroneous therapies for SCEH patients might increase the hematoma size, aggravate symptoms, or even lead to permanent damage or death [5, 6], it is of great importance to rapidly and accurately differentiate these two diseases.…”

Section: Introductionmentioning

confidence: 99%

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How to Avoid Misdiagnosing Spontaneous Cervical Spinal Epidural Hematoma as Ischemic Stroke: 3 Case Reports and Literature Review

Cui

et al. 2022

Cerebrovasc Dis

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When spontaneous cervical spinal epidural hematoma (SCEH) presents with hemiparesis, it can be misdiagnosed with ischemic stroke (IS), and the treatment of IS such as thrombolysis may deteriorate the symptoms of patients with SCEH, leading to worse sequelae or even death. We reported 3 SCEH patients who were initially suspected as IS in our center between Jun 2020 and April 2022 and analyzed their clinical characteristics together with 48 patients reported in the literature from Jan 1995 to April 2022. Two of the 3 SCEH patients had neck symptoms, while none of them presented cranial nerve symptoms. Cranial computed tomography (CT) scans were negative; however, abnormal signals in the cervical spinal canal were observed during cranial computed tomography angiography (CTA) and subsequent cervical CT confirmed the diagnosis of SCEH. All of them avoid mistreatment with recombinant tissue plasminogen activator (rt-PA). Subsequently, we analyzed the clinical characteristics of a total of 51 patients. Thirteen of them developed symptoms during activity. Neck pain was an important sign of SCEH because 35 patients had neck pain or neck discomfort. Sensory impairment was reported in a small proportion of patients (11/51), which varied a lot in the patients. Some special manifestations highly suggested spinal cord lesions and provided evidence for the early differential diagnosis of SCEH and stroke, but the incidence of which was quite low: ipsilateral Horner syndrome in 2 patients, Brown-Séquard syndrome in 2 cases, and Lhermitte’s sign in 1 case. Only a minority (8/51) of the patients were correctly diagnosed at the emergency unit using cervical CT. Six patients were correctly diagnosed when performing CTA. A large portion of the cases (21/51) were first misdiagnosed as IS, but no responsible lesions were found on cranial magnetic resonance imaging (MRI), and subsequent cervical MRI confirmed the diagnosis. Sixteen patients were diagnosed with SCEH after the deterioration of symptoms. A total of 13 patients received rt-PA, and 10 of them had symptoms aggravation after thrombolysis. For patients with acute onset of hemiparesis but without cranial nerve symptoms, especially those accompanied by clinical features such as neck pain, ipsilateral Horner syndrome, Brown-Séquard syndrome, and Lhermitte’s sign, SCEH should be highly suspected rather than stroke. Careful differential diagnosis should be performed with a comprehensive medical history and thorough physical examination. Cervical CT scan is a reasonable choice for quick differential diagnosis prior to administering potentially harmful therapy, especially rt-PA.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

How to Avoid Misdiagnosing Spontaneous Cervical Spinal Epidural Hematoma as Ischemic Stroke: 3 Case Reports and Literature Review

Cui

et al. 2022

Cerebrovasc Dis

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show abstract

“…Current treatments in thrombotic patients have been clinically studied and tested. Thus, there are several prospectives works (Novotny et al, 2014;Ozdemir et al, 2014;Ghadirpour et al, 2014) and meta-studies (Sun et al, 2014;Martino et al, 2012;Reynaud et al, 2014) that Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/jbiomech www.JBiomech.com investigate the effect of treatments after the diagnosis of DVT. Numerical simulations of the genesis of thrombus in different veins have also been reported (Cito et al, 2013;Ataullakhanov and Panteleev, 2005).…”

Section: Introductionmentioning

confidence: 99%