Spontaneous cervical epidural hematoma in a patient with <scp>end‐stage</scp> renal disease

Huang, Chin‐Te; Lin, Chien-Hao; Wang, Hsiu-Po; Lien, Wan‐Ching

doi:10.1111/hdi.12970

Cited by 3 publications

(3 citation statements)

References 12 publications

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“…The pathophysiology of SCEH is currently unknown. Although comorbidities with bleeding tendency might contribute to SCEH, only 17.6% of patients (9/51) had bleeding-related risk factors in this study [6, 10-14]. Other comorbidities such as hypertension, diabetes, and dyslipidemia might be related to age, considering that 94.1% of patients were aged more than 50 years.…”

Section: Discussionmentioning

confidence: 71%

“…However, some patients could only have neck pain with radiculopathy similar to cervical spondylopathy and could easily be ignored [12]. Some patients might even have no neck pain similar to 16 patients in our review [30][31][32][33][34][35]. Furthermore, we should know that sudden hemiparesis combined with neck pain was also seen in patients with carotid artery dissection [36].…”

Section: Discussionmentioning

confidence: 91%

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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: 71%

Section: Discussionmentioning

confidence: 91%

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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“…In a similar report, Huang et al . 37 reported a 71-year-old patient with ESRD (Cr=8.7) who developed cervical SSEDH and was treated surgically. Both of these cases had severe uraemia and ESRD which may be associated with an acquired platelet dysfunction and/or coagulopathy and lead to SSEH, however, the data on this correlation is not conclusive.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous spinal epidural haematoma following COVID-19 vaccination: a case report

Rezvani,

Sabouri,

Aminmansour

et al. 2023

Annals of Medicine &Amp; Surgery

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Introduction: COVID-19 vaccination side effects are rare but important medical situations. Spine-affecting side effects are amongst the rarest, but exceedingly important. Haemorrhagic spinal manifestations of COVID-19 and its vaccines are less reported with little knowledge about them. Case presentation: An 80-year-old male who received his first shot of the COVID-19 vaccine had developed COVID-19 pneumonia, weakness, and sensory problems in his legs followed by sphincter incontinence within 5 days period. MRI showed a spontaneous epidural spinal epidural haematoma (SSEDH) in T10–L1. He underwent laminectomy and haematoma evacuation. One month follow-up showed no clinical improvement. Discussion: To our knowledge, this was the first post-vaccination SSEDH and second in haemorrhagic spinal complications following COVID-19 vaccination. Considering the neuropathogenesis pathway of COVID-19 and its vaccines, there are common mechanisms of action that could potentially justify post-vaccination SSEDH such as seen in COVID-19 infection, itself. Early Neurosurgical intervention and better preoperative neurological status could be a beneficial modifier for favourable clinical outcomes. Conclusion: SSEDH and COVID-19 vaccine coincidence is a rare clinical event, still no solid association could be scientifically explained. Further studies are required for a reliable pathophysiologic association. Early diagnosis, interdisciplinary medical approach, and faster intervention are the cornerstone of the treatment paradigm.

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Prognostic factors and surgical outcomes of spontaneous spinal epidural haematoma: a systematic review and meta-analysis

et al. 2022

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Spontaneous cervical epidural hematoma in a patient with end‐stage renal disease

Cited by 3 publications

References 12 publications

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

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

Spontaneous spinal epidural haematoma following COVID-19 vaccination: a case report

Prognostic factors and surgical outcomes of spontaneous spinal epidural haematoma: a systematic review and meta-analysis

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