Spontaneous cervical epidural hematoma with stroke manifestations

Abstract

Spontaneous cervical epidural hematoma (SCEH), which is a rare disease, is manifested as by a sudden quadriplegia or paraplegia and other neurological deficits. SCEH can compress the spinal cord resulting in its clinical manifestations. The reported etiological risk factors are anticoagulants, coagulopathies, vascular malformations, infections, and herniated discs. Here, we report a 77-year-old woman with a presenting chief complaint of left hemiparesis and a history of hypertension. The medical drugs in use were aspirin and antihypertensives. The initiating presentations were hemiparesis, in favor of ischemic stroke, so the patient admitted to neurology ward and received anticoagulant therapy with the initial diagnosis of stroke. Although clinical manifestations and examinations are important in these patients due to mimicking stroke picture, imaging evaluation is paramount for a definite diagnosis, which in our case showed a SCEH, who was suspected to have an ischemic stroke during the initial assessment because its initial demonstration mimicked ischemic stroke. This patient underwent laminectomy after 3 days and showed a clinical recovery the day after. Her muscle strength improved gradually, and neurological symptoms were diminished after physiotherapy.

Acute Spinal Extradural Hematoma and Cord Compression: Case Report and a Literature Review

“…The classical symptoms exhibited in the patients presenting with epidural hematomas included sensory and motor deficits, sphincter dysfunction, Brown Sequard Syndrome, and even cauda equine syndrome [7]. The epidural hematoma symptoms in our patient were the complete loss of sensory and motor sensation, which was also reported in other patients with a similar issue [2].…”

“…The etiology of spontaneous epidural hematomas is not very well established. Although some studies have postulated a probable correlation of epidural hematomas to different factors such as antiplatelet and anticoagulant use, blood coagulopathies, vascular malformations, tumors, pregnancy, and Paget's disease, a vast majority of the cases (40-50%) remain idiopathic [2]. In our case, the patient had a history of diabetes mellitus, hypertension, chronic kidney disease, and coronary artery disease.…”

“…Of these hematomas, spinal epidural hematoma (SEH) is a rare condition (0.1/100,000 patients per year) with male dominance of 3:1 and affecting mostly in the age group of 42-52 years olds [1]. The disease commonly occurs in association with factors such as trauma, coagulopathies, and epidural intervention [2]. Some spontaneous SEH cases were reported, which were idiopathic (one-third of the cases) and chronic.…”

“…The hematomas have been reported in cervicothoracic and thoracolumbar regions commonly, and the resultant cord compression has led to neurological deficits like quadriplegia and paraplegia in many reported cases [1,5,6]. Most of these cases showed a good prognosis when the immediate intervention was done, preferably a surgical one [2][3][4]. Although some cases even demonstrated good outcomes by giving medication when the surgical interventions were contraindicated or not available [1].…”

“…Although some cases even demonstrated good outcomes by giving medication when the surgical interventions were contraindicated or not available [1]. In cases where immediate intervention was not done, irreversible neurological deficits, i.e., cord compression syndrome or even death, were reported [2].…”