Spontaneous epidural hematoma of thoracic spine presenting as Brown-Séquard syndrome: report of a case with review of the literature

Abstract

Although Brown-Séquard syndrome as a presenting feature of SSEH is rare, it does exist in exceptional case, which should be taken into consideration for differential diagnosis. Prompt surgical decompression is an absolute surgical indication widely accepted for patient with progressive neurological deficit. However, SSEH presenting with incomplete neurological insult such as Brown-Séquard syndrome might have a benign course. Successful non-operative management of this problem does not make it a standard of care, and surgical decompression remains the standard treatment for SSEH.

Spontaneous spinal epidural hematoma with hemiparesis mimicking acute cerebral infarction: Two case reports

“…Moreover, 5 of the 13 cases showed Brown-Séquard's syndrome initially or during the clinical course. 9,12 Although these two patients displayed neither Brown-Séquard's syndrome nor Horner's syndrome, clinicians should be aware that these syndromes may also indicate the possibility of SSEH. Recently, intravenous thrombolytic treatment with alteplase initiated within 3 hours of symptom onset has been approved in most countries for treatment of acute ischemic stroke.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12] The incidence of SSEH is estimated to be 0.1 patient per 100 000 individuals. 3 SSEH typically presents acute onset of severe back pain and signs of compression of the spinal cord rapidly develop.…”

“…3 SSEH typically presents acute onset of severe back pain and signs of compression of the spinal cord rapidly develop. [1][2][3][4][5][6][7][8][9][10][11][12] Although hemiparesis due to SSEH is a relatively uncommon symptom compared with tetraparesis, a few cases of hemiparesis due to SSEH have been reported. 1,2,[4][5][6][7][8][9][10][11] Patients with hemiparesis due to SSEH have often been misdiagnosed as cerebral infarction and treated with anti-platelet therapy or anticoagulation.…”

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“…There were multiple case reports from different parts of the world mostly reported in spine and neurosurgical literature [2][3][4][5], regarding spontaneous epidural hematoma [6]. Our case was different in the sense patient that there was a hematoma around the tumor as seen by the operating neurosurgeon and was removed enblock, further investigations regarding possible metastasis are underway.…”

Pearls & Oy-sters: Localization in acute stroke management

“…Prompt recognition of this association with early surgical evacuation can lead to good longterm outcomes. 10 Our case highlights the importance of localizing stroke syndrome and elucidating possible stroke mechanisms before initiating acute stroke therapy with IV rtPA. This can be extremely challenging, especially so when we act within a very tight therapeutic window with ever more emphasis on the fact that "time lost is brain lost."…”