Case Report and Literature Review: Lumbar Disc Extrusion Misdiagnosed as an Epidural Hematoma

Abstract

Accurate differentiation between epidural hematomas and lumbar disc extrusion is essential due to the potential overlap in clinical presentations. We present a case report highlighting a significant challenge in which a massive lumbar disc extrusion was mistaken for an epidural hematoma. This is a case report of a 38-year-old male patient who developed cauda equina syndrome four days after experiencing an audible cracking in the lower back during weightlifting activity. Magnetic resonance imaging (MRI) was inconclusive, unable to distinguish between an extruded nucleus pulposus and a spinal epidural hematoma. Subsequently, an urgent operation revealed a large herniated disc at the L4-L5 level, ruling out any hematoma. The patient's post-operative follow-up showed significant improvement, with almost complete recovery of motor and sensory functions. This case emphasizes the challenges faced when distinguishing between epidural hematomas and lumbar disc herniations, particularly on MRI. The lumbar disc herniation's substantial size, cranial and caudal migration on multiple levels, and signal intensity contributed to the misdiagnosis, underscoring the importance of careful interpretation and awareness of such complexities.

Thoracic root–related intradural extramedullary cavernoma presenting with subarachnoid hemorrhage: illustrative case

“…Numerous cases of MRI-related misdiagnoses or imprecise definitions have been published. 1 , 23 , 24 Even with gadolinium-enhanced sequences, it can be challenging to distinguish between a degenerative condition such as a disc herniation and a neoplastic entity. This difficulty arises because of varying patterns of enhancement influenced by local inflammatory responses, potentially leading to an inaccurate diagnosis.…”