Spontaneous Epidural Hematoma of the Cervical Spine Mimicking a Cerebrovascular Accident: A Case Report

Abstract

Objective The present study is a case report of a 57-year-old female with controlled hypertension who presented with spontaneous spinal epidural hematoma (SSEH) mimicking a cerebrovascular accident (CVA) and was successfully treated by surgical decompression. Methods A 57-year-old woman with a medical history of hypertension presented with a sudden onset of weakness in the right upper and lower extremities. Weakness of grade 3/5 was noted in her right upper and lower extremities, but there was no motor weakness of the right facial muscles. A magnetic resonance imaging (MRI) exam of the cervical spine revealed an epidural hematoma extending from level C5 to level C7, causing spinal cord compression. Results During surgery, a cervical spinal epidural hematoma (SEH) was evacuated. Postoperatively, the power in both limbs improved to grade 5/5 just after surgery. Conclusions A high degree of suspicion, meticulous history taking, and physical examination have a great importance in these rare conditions because anticoagulant therapy as a routine treatment for ischemic CVA could be life-threatening. Palavras-chave► hematoma epidural espinhal espontâneo ► coluna cervical ResumoObjetivo O presente estudo se trata de um relato de caso de uma paciente de 57 anos, com hipertensão controlada, que apresentou um hematoma epidural espinhal espontâneo (HEEE) imitando um acidente vascular cerebral (AVC), e que foi tratada com sucesso através de descompressão cirúrgica. Métodos Uma mulher de 57 anos com um histórico de hipertensão apresentou um súbito princípio de fraqueza nas extremidades superior e inferior do lado direito. Foi notada força muscular de grau 3/5 em suas extremidades superior e inferior do lado direito, mas não houve fraqueza motora dos músculos faciais no lado direito. Um exame de ressonância magnética (RM) da coluna cervical revelou um hematoma epidural estendendo-se do nível C5 ao nível C7, causando uma compressão medular.

Spontaneous idiopathic spinal subdural hemorrhage in a 16‐year‐old boy: A rare case in pediatrics and review of literature

“… 15 The lesion often develops on the thoracic and lumbar spinal and rarely in the cervical area. 3 Our patient presented with severe sudden onset cervical pain, left side weakness and Brown Squared symptoms for two days before admission. For diagnosis of spontaneous SDH, MRI is considered the gold standard in evaluation and monitoring of spinal hematomas.…”

“…Pathophysiology of spontaneous SSDH can be the rupture of the radiculomedullary veins in the subarachnoid space following the trauma or increased intra‐abdominal or intra‐thoracic pressure 15 . The lesion often develops on the thoracic and lumbar spinal and rarely in the cervical area 3 . Our patient presented with severe sudden onset cervical pain, left side weakness and Brown Squared symptoms for two days before admission.…”

“…The clinical manifestations of SSDH are related to cord compression and vary from back pain to motor, sensory, and autonomic dysfunction. 3 , 4 The main approach for confirming the diagnosis is magnetic resonance imaging (MRI). 5 Although surgical intervention through decompression is considered as the main treatment option, percutaneous drainage or conservative therapies are also introduced.…”

“…The clinical manifestations of SSDH are related to cord compression and vary from back pain to motor, sensory, and autonomic dysfunction 3,4 . The main approach for confirming the diagnosis is magnetic resonance imaging (MRI) 5 .…”

Spontaneous idiopathic spinal subdural hemorrhage in a 16- year-old boy: The 1st case report in pediatrics and review of literature

“…The clinical manifestations of SSDH are related to cord compression and vary from back pain to motor, sensory, and autonomic dysfunction (3,4). The main approach for confirming the diagnosis is magnetic resonance imaging (MRI) (5).…”