An unusual presentation of spontaneous spinal epidural hematoma

Risavi, Brian L.; Reese, Erin M.; Knott, Mary

doi:10.1002/emp2.12925

Cited by 4 publications

(2 citation statements)

References 32 publications

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“…Additionally, soft tissue CT scans are necessary [12]. However, it is important to note that the absence of abnormalities on soft tissue CT scans does not completely exclude a neck lesion, and several studies have demonstrated that MRI is the preferred imaging modality for SCEH [5,[13][14][15] as it enables clear differentiation between the two types of cervical lesions [16]. The results of this study can be summarized as follows.…”

Section: Discussionmentioning

confidence: 93%

Spontaneous Cervical Epidural Hematoma Misdiagnosed as Stroke: A Case Report and Literature Review

Cui,

Wang,

et al. 2023

Preprint

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Background Spontaneous cervical epidural hematoma (SCEH) is a clinically rare condition that can lead to quadriplegia or hemiparesis due to compression of the spinal cord by a hematoma. This condition is often misdiagnosed as stroke, and administering thrombolysis can have serious consequences.Case presentation: In this case, a 74-year-old woman presented with neck and shoulder pain following poor posture during her lunch break, which was further aggravated after receiving a massage from family members, leading to complete right hemiparesis. The patient was promptly taken to the emergency room, where thrombolytic therapy was administered based on the Stroke Scale score, cranial CT, and cervical CT to rule out hemorrhage. Unfortunately, the patient's symptoms worsened after thrombolytic therapy. Subsequently, she was admitted to the neurology department, where rehydration and dehydration therapy resulted in improvement. However, her symptoms reappeared due to inappropriate anticoagulation therapy. An orthopedic surgeon was consulted, and considering the patient's history of neck pain and the possibility of cervical lesions, an acute cervical MRI was performed. The MRI revealed a slightly long T2 signal within the lamellar region of the C2-4 spinal cord. Upon review and comparison with the initial cervical CT, the diagnosis was revised to cervical spine spontaneous epidural hematoma. Urgent surgical decompression was then performed, resulting in improved neurological symptoms.Conclusion SCEH is a rare but disabling and potentially fatal disease. Clinicians should be aware of its typical symptoms and include it as a vital differential diagnosis to avoid misdiagnosis as stroke. Caution should be exercised when considering anticoagulation and thrombolytic therapy before and after the diagnosis of SCEH. Early diagnosis and timely surgical treatment can significantly improve neurological and functional outcomes, although identifying this condition remains challenging for clinicians.

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Section: Discussionmentioning

confidence: 93%

Spontaneous Cervical Epidural Hematoma Misdiagnosed as Stroke: A Case Report and Literature Review

Cui,

Wang,

et al. 2023

Preprint

View full text Add to dashboard Cite

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“…Patients who undergo surgery within 24 h of symptom onset have a recovery rate of 47% [25] . Furthermore, the prognosis is often poorer if a patient experiences symptoms for 36 h without undergoing surgical decompression [26] .…”

Section: Discussionmentioning

confidence: 99%