Spontaneous cervical epidural haematoma mimicking stroke: a case report and literature review

Abstract

Spontaneous spinal epidural haematoma (SSEH) is a rare disease that requires emergency decompression or haematoma evacuation to prevent permanent neurological deficits. Hemiparesis is an extremely rare presentation of SSEH, commonly misdiagnosed as stroke. With the help of case studies and references, this paper comprehensively discusses the effective methods to distinguish SSEH from stroke and provides theoretical support and ideas for rapid and accurate identification of SSEH. Herein, we report on the case of a 51-year-old man with SSEH who presented with acute hemiparesis and posterior neck pain. Cervical computed tomography (CT) revealed cervical degeneration. A carotid CT angiogram revealed a high-density mass in the C2-C5 right posterolateral epidural region. Cervical spine magnetic resonance imaging showed SSEH. The patient was conservatively treated and discharged following a full recovery. Rapid identification of SSEH continues to present a great challenge for neurologists. A soft tissue CT scan can be used to quickly and accurately identify SSEH; however, in the absence of cranial signs, Brown-Sequard syndrome, Lhermitte's sign and Horner syndrome should be used to differentiate SSEH from stroke.

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

“…Secondly, the interpretation of the hematoma on CT scans: the Houns eld unit (HU) setting of a hematoma on CT scans is generally between 50-90HU, similar to that of soft tissue in the standard window. However, the HU in the bone window is signi cantly higher than that in the soft tissue window [11], resulting in reduced recognition of soft tissue and hematoma under the bone window. In this case, the clinician lacked experience with interpreting soft tissue CT scans of the neck for SCEH and overlooked the imaging ndings.…”

Distinguishing Cerebral Infarction With Neck Pain and Hemiparesis From Cervical Spinal Epidural Hematoma Without MRI: A Case Report

“…It is crucial to include a cervical spinal epidural hematoma in the differential diagnosis of patients experiencing sudden neck pain and subsequent hemiparesis [6,9,10]. Misdiagnosing a cervical spinal epidural hematoma as a stroke can result in poor clinical outcomes due to inappropriate treatment through antithrombotic therapy [3][4][5][6][7][8][9][10].…”

“…Plain CT of the cervical spine is a valuable tool in diagnosing spinal epidural hematoma [8,10,11,[14][15][16]. CT findings of this hematoma vary depending on its phase.…”

“…Air or metal artifacts increase the risk of misdiagnosis. Although plain CT also provides acceptable results, the potential for misdiagnosis remains with this modality [8,10,11,[14][15][16].…”

“…Stroke mimics are a group of diseases that exhibit stroke-like clinical features, such as acute onset and localized neurological deficits due to symptoms caused by diseases other than cerebrovascular disorders [3,4]. Cervical epidural hematoma can mimic stroke, and intravenous thrombolysis can have disastrous consequences [3][4][5][6][7][8][9][10].…”