Spontaneous Spinal Epidural Hematoma Presenting as Stroke Mimic
Shu Ting Wang, MD 1 , Li Chi Hsu, MD 1 , Feng Chi Chang, MD 2 ,
1 Department of Neurology, Taipei-Veterans General Hospital
2 Department of Radiology, Taipei-Veterans General Hospital
Shu Ting Wang , MD
Department of Neurology, Taipei-Veterans General Hospital
Hemiparesis is the manifestation of several neurological disorders, such as stroke, neoplasms. It may also occur due to a lesion located in the cervical spinal cord. We report a case of spontaneous cervical spinal epidural hematoma with left hemiparesis and misdiagnosed as stroke (stroke mimic). Care report : An 84-year-old female visited emergency department with the chief complaint of acute onset of left limbs weakness. She also stated neck pain and left shoulder pain. Routine laboratory studies were all normal. Neurological examination demonstrated mild dysarthria and left central facial palsy, decreased left limbs muscle power, no sensory impairment and absent Babinski response. Ischemic stroke was impressed initially. But computed tomography (CT) and magnetic resonance imaging (MRI) of brain showed no obvious abnormality. She was admitted for conservative treatment of stroke. However, deterioration of left limbs weakness was noted, with persistent neck pain. MRI of cervical spine revealed an epidural hematoma at left dorsal aspect of C4-T2 level with compression of the cervical spinal cord. So the patient received C3-T4 laminectomy and epidural hematoma removal. The muscle power of left limbs improved post-operatively.
Spontaneous spinal epidural hematoma (SSEH) is a rare neurological emergency of the spinal cord. Most patients present with motor dysfunction such as paraparesis and tetraparesis, accompanied by neck or back pain. SSEH presenting as hemiparesis is less common and can be mistaken for a cerebrovascular accident (CVA). The mainstay of treatment is surgical evacuation, combined with decompressive laminectomy. The degree of preoperative neurological deficit and the interval between the onset and surgery are critical prognostic factors. A high index of suspicion, appropriate investigation and immediate intervention can reduce morbidity in SSEH patients.