Spontaneous Cervical Epidural Hematoma with Hemiparesis Mimicking Cerebral Stroke

Abstract

Aim. Spontaneous cervical epidural hematoma (SCEH) is defined as an epidural hematoma that does not have an etiological explanation. The most common site for SCEH is cervicothoracic area. Early diagnosis and treatment are important for prognosis and good results. In this paper, we aimed to present a case who complains of sudden weakness on right extremities imitating cerebral stroke and that neuroimaging reveals spontaneous cervical epidural hematoma. Case. A 72-year-old woman was admitted to our hospital with acute neck pain and loss of strength on right extremities. On neurological examination, the patient had right hemiparesis. PT, aPTT, and INR results were 50.5, 42.8, and 4.8, respectively. Cranial MRI was in normal limits. Spinal MRI revealed a lesion that extends from C4 to C7 located on the right side and compatible with epidural hematoma. The patient was operated after normalization of INR values. Conclusion. Even though SCEH is a rare condition, it can cause severe morbidity and mortality. Early diagnosis and treatment are quiet important for prognosis. SCEH can easily be mistaken for stroke as with other pathologies and this diagnosis should come to mind especially in patients who have diathesis of bleeding.

A Case Report: The Challenging Diagnosis of Spontaneous Cervical Epidural Hematoma

“…SCEH are a dynamic process that often begin with localized neck pain as blood collects in the epidural space, and can progress to paresthesia, paraplegia, quadriplegia, or hemiparesis as the hematoma expands and subsequently compresses the spinal cord. 2,9 This is the same progression we witnessed in our patient. Taha et al described a 41-year-old man diagnosed with SCEH who presented with six days of neck pain radiating to both upper extremities that subsequently progressed to quadriparesis and urinary urgency.…”

“…8 Although various causes have been attributed to SCEH, including the use of antithrombotic medications, in as many as 40-50% of the cases the exact cause remains unknown. 2,9 It is likely that the daily low-dose aspirin played a role in our patient.…”

A Spontaneous Thoracic Spinal Epidural Hematoma Causing Hemiplegia and Back Pain

“…However, Miyagi et al reported that arterial blood supply is a more persuasive force for pressure inside the venous plexus as it is lower than that in the epidural space. Furthermore, in some cases, rapidly deteriorating neurological deficits after the initial onset of back pain or lumbago indicated a rapid formation of the hematoma and spinal cord compression, which is suggestive of the arterial origin of spontaneous SEH (6).…”

A spontaneous cervical epidural hematoma mimicking a stroke – A case report

“…[5,8] e classical clinical presentation is acute neck or interscapular pain, and as a result of the spinal cord compression sensory and motor loss may be seen, such as paraparesis, quadriparesis, or Brown-Sequard syndrome. [2,14] Although in some cases, a pure motor hemiparesis may be seen and mistaken for cerebrovascular stroke. [14] erefore, early diagnosis and treatment are essential for good prognosis.…”

“…[2,14] Although in some cases, a pure motor hemiparesis may be seen and mistaken for cerebrovascular stroke. [14] erefore, early diagnosis and treatment are essential for good prognosis.…”