Acute Spontaneous Cervical Epidural Hematoma Mimicking Cerebral Stroke: A Case Report and Literature Review

Abstract

Spontaneous cervical epidural hematoma (SCEDH) is a rare disease, but can cause severe neurologic impairment. We report a case of a 68-year-old female who presented with sudden onset, posterior neck pain, right shoulder pain, and progressive right hemiparesis mimicking stroke with no trauma history. Initial brain CT and diffusion MRI performed to rule out brain lesion did not show any positive findings. Laboratory examination presented only severe thrombocytopenia (45,000/mm3). Subsequent cervical MRI revealed a cervical epidural mass lesion. We confirmed that it was pure hematoma through C5 unilateral total laminectomy and C6 partial hemilaminectomy. She achieved complete neurologic recovery with active rehabilitation. Early surgical decompression for SCEDH with neurologic impairment should be recommended for better outcome.

Spontaneous Spinal Epidural Hematoma: A Case Report

“…However, the initial presentations of SSEH are often miscellaneous and atypical. The initial symptoms can occasionally mimic disc prolapse and even rarely be misdiagnosed as transient ischemic attack or stroke [12, 13]. …”

Traumatic C1–C3 Spinal Epidural Hematoma Presented with Occipital Neuralgia

“…Cord compression causes myelopathy and cord syndromes. Because of the variety of symptoms, SEH is sometimes not suspected at initial presentation and can reportedly occasionally mimic stroke or cord injury 2,4,5,8,9) . In polytraumatic patients, other injuries may mask SEH.…”

Inpatient rehabilitation following operative spontaneous spinal epidural hematoma mimicking stroke: a case report

“…2 Etiologies include blood coagulopathies, anticoagulant treatment, infection, tumorigenesis, pregnancy, herniated discs, Paget's disease and vascular malformations. 6 Although clinical presentation and neurologic examination are important, imaging studies of the SSEH are the most reliable diagnostic tool, 2 magnetic resonance imaging being the test of choice. It provides information about the nature and extent of the hematoma, as well as the degree of cord compression.…”

“…10 Because there is a tendency for neurologic progression, most patients are treated with prompt decompressive surgery within 36 h. 10 There have also been reported significantly better outcomes for patients with complete neurologic deficit that underwent decompression within 36 h of symptom onset 11 and within 48 h in patients with incomplete deficit. 6 These data suggest that early diagnosis and prompt surgical decompression are the key for improved neurological recovery. [12][13][14][15][16][17] Although there are extensive data published about the relationship between prompt surgical decompression and neurological outcomes, there are no data on recovery following inpatient rehabilitation.…”