Neck pain and absence of cranial nerve symptom are clues of cervical myelopathy mimicking stroke: Two case reports

Abstract

BACKGROUND Cervical myelopathy is a potential stroke imitator, for which intravenous thrombolysis would be catastrophic. CASE SUMMARY We herein present two cases of cervical myelopathy. The first patient presented with acute onset of right hemiparesis and urinary incontinence, and the second patient presented with sudden-onset right leg monoplegia. The initial diagnoses for both of them were ischemic stroke. However, both of them lacked cranial nerve symptom and suffered neck pain at the beginning of onset. Their cervical spinal cord lesions were finally confirmed by cervical computed tomography. A literature review showed that neck pain and absence of cranial nerve symptom are clues of cervical myelopathy. CONCLUSION The current report and the review remind us to pay more attention to these two clues in suspected stroke patients, especially those within the thrombolytic time window.

Conservative management of spontaneous spinal epidural hematoma: A case report with favorable prognosis

“…The patient was then transferred to us due to suspicion of a cervical epidural hematoma. Since the distribution of hematoma varies from side to side, hemiplegia and Brown‐Séquard syndrome‐like symptoms may occur; differentiation from cerebral infarction is particularly important 11 . In this case, the hematoma was located slightly to the right posterior to the spinal cord, and there was no association between the location of the hematoma and neurologic symptoms.…”

Distinguishing Cerebral Infarction With Neck Pain and Hemiparesis From Cervical Spinal Epidural Hematoma Without MRI: A Case Report

“…The onset of neck or back pain and the absence of cranial nerve signs have been suggested as important indicators for diagnosing cervical spinal epidural hematoma with hemiparesis [ 6 , 9 , 10 ]. However, a recent review found that 16 out of 51 cases presented with hemiplegia without neck pain, and 6 out of 51 cases presented with hemiplegia and dysarthria [ 8 ].…”

“…Typical symptoms of cervical epidural hematoma with hemiparesis are neck pain and absence of cranial nerve symptoms [ 6 , 9 , 10 ]. These symptoms are similar to hemorrhagic stroke, including subarachnoid hemorrhage, and ischemic stroke, including arterial dissection.…”

“…It is crucial to include a cervical spinal epidural hematoma in the differential diagnosis of patients experiencing sudden neck pain and subsequent hemiparesis [6,9,10]. Misdiagnosing a cervical spinal epidural hematoma as a stroke can result in poor clinical outcomes due to inappropriate treatment through antithrombotic therapy [3][4][5][6][7][8][9][10].…”

“…Stroke mimics are a group of diseases that exhibit stroke-like clinical features, such as acute onset and localized neurological deficits due to symptoms caused by diseases other than cerebrovascular disorders [3,4]. Cervical epidural hematoma can mimic stroke, and intravenous thrombolysis can have disastrous consequences [3][4][5][6][7][8][9][10].…”