Spontaneous spinal epidural hematoma mimicking acute ischemic stroke
I-Chen Lee, MD 1 , Meng-Ni Wu, MD 1 ,
1 高雄醫學大學附設中和醫院, 神經部
1 Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
I-Chen Lee , MD
Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
A 90-year-old woman, receiving regular aspirin 100 mg per day for ischemic heart disease, presented with acute onset of right-sided weakness with concurrent neck pain after urination. She was sent to emergency room under the suspicion of acute stroke. There was no concurrent dysarthria, choking, drooling, facial numbness or ptosis. However, she complained paresthesia involving right shoulder and upper arm. Neurological examination revealed right-sided areflexia and hemiplegia (MRC muscle strength of 0) without response to Barbinski sign test. Decreased sensation was identified on right neck, shoulder, arm and forearm with positive Lhermitte's sign. Multiphase computed tomography angiography, indicating for acute stroke protocol, did not reveal significant intracranial lesion. Conversely, it disclosed a spinal epidural hematoma involving 2nd -7th cervical segment with cord compression. Emergent endovascular thrombectomy and antiplatelet agent were discontinued. Instead, Tranexamic acid 250 mg was loaded with consultation of neurosurgeon.
The SEDH may mimic acute stroke but is contraindicated for therapy for acute ischemic stroke. Therefore, we highlight that SEDH should be excluded in patients with uncommon distribution of bulbar-sparing neurological deficits and newly-onset of neck pain with Lhermitte's sign before they receive therapy for acute ischemic stroke