Spontaneous Spinal Epidural Hematoma: An Atypical Clinical Presentation and Discussion of Management

Shah, Jason A.; Patel, Nick N.; Michael, Keith W.

doi:10.14444/7030

Cited by 5 publications

(6 citation statements)

References 12 publications

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“…Patients who present with more severe symptoms within a shorter time frame tend to have larger hematomas; these are associated with worse outcomes, particularly when four or more spinal segments are involved [7][8][9]. And these were the same findings of our reported case.…”

Section: Discussionsupporting

confidence: 85%

Management and outcome of spontaneous cervical epidural hematoma: Case report and review of the literature

Dokponou¹,

Belhachmi²,

Imoumby³

et al. 2021

World J. Adv. Res. Rev.

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Spontaneous spinal epidural hematomas are rare and potentially disabling neurological emergencies. Its lead to devastating neurologic outcomes and most patient does not recover completely. The clinical presentation is diverse and includes a severe acute attack, radiating pain at the back, interscapular, or neurological deficits. We report a case of a young woman, 24-year-old, that was admitted to our department for sudden non-traumatic cervical spinal cord compression syndrome (Type A of the American Spinal Cord Injury Association “ASIA A”) including intense cervical back pain, sensory loss, and tetraplegia. Her past medical history was unremarkable. The MRI confirmed a cervical mass responsible for the spinal cord compression and the emergent surgical intervention allow us to evacuate acute C3-C7 hematoma. The patient never recovers from the neurologic deficit despite the emergent management of her case followed by functional musculoskeletal rehabilitation for two years.

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Section: Discussionsupporting

confidence: 85%

Management and outcome of spontaneous cervical epidural hematoma: Case report and review of the literature

Dokponou¹,

Belhachmi²,

Imoumby³

et al. 2021

World J. Adv. Res. Rev.

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“…SSEH usually presents as Brown-Sequard syndrome, paraparesis or tetraparesis, with cervical or back pain. Hemiparesis is a very rare presentation of SSEH that is commonly misdiagnosed as acute ischemic (cerebral) stroke (AIS) [1,2,[4][5][6][8][9][10][11][12][13][14][15]. In patients whose symptoms were mistaken for AIS, treatment with heparin, rt-PA, aspirin and warfarin worsened their condition [1,2,[4][5][6]8,[12][13][14][15].…”

Section: Discussionmentioning

confidence: 99%

“…SSEH commonly presents as tetraparesis, paraparesis or Brown-Sequard syndrome. Hemiparesis is an extremely rare presentation of SSEH that is commonly mistaken for stroke [1,2,[4][5][6][8][9][10][11][12][13][14][15]. Timely and accurate diagnosis remains challenging for neurologists.…”

Section: Introductionmentioning

confidence: 99%

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

Lv¹,

Bao²,

Lou³

et al. 2022

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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.

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“…Spinal epidural hematomas (SEH) usually occur under certain risk factors, and spontaneous occurrence is rare (0.1/100000) with a male-to-female ratio of 1.4/1 (1). Multiple case series of SEH have been described, showing different clinical presentations starting with sudden back and neck pain and progressing to paresthesia and even complete quadriplegia (2).…”

Section: Introductionmentioning

confidence: 99%

A case of spontaneous spinal epidural hematoma with stroke symptoms

Yıldırım,

Uysal,

Akdağ

2024

Med Sci Discov

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Objective: Spontaneous spinal epidural hematoma (SSEH) can present with symptoms resembling stroke, potentially leading to misdiagnosis and inappropriate treatment. In this case report, we aim to present a patient with SSEH whose clinical findings mimicked those of ischemic stroke. Case Presentation: A 78-year-old woman presented to the emergency department with sudden weakness in her left arm and leg. Motor examination revealed a strength value of 3-4/5 in the left upper and lower extremities. Brain computed tomography (CT) and brain diffusion magnetic resonance imaging (MRI) showed no acute neurological pathology. However, cervical MRI revealed heterogeneous signal areas in the extradural region posterior to the C3-C5 level. Further evaluation with cervical spinal CT identified an epidural hematoma. The patient was referred to neurosurgery, and surgical intervention was planned. Following surgery, the patient's motor strength was assessed as 2-3/5 in the upper and lower extremities. Conclusions: SSEH can occur in patients with multiple risk factors, although significant risk factors were not identified in our case. Paraparesis and tetraparesis are more commonly observed presentations of SSEH than hemiparesis. In our case, hemiparesis was an initial finding that resembled stroke symptoms. SSEH most frequently occurs at the C6 and T12 vertebral levels, making the location of our patient's lesion between the C3-C5 vertebrae even rarer. In summary, SSEH may rarely present with symptoms mimicking stroke, emphasizing the importance of accurate diagnosis to avoid mismanagement.

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Spontaneous Spinal Epidural Hematoma: An Atypical Clinical Presentation and Discussion of Management

Cited by 5 publications

References 12 publications

Management and outcome of spontaneous cervical epidural hematoma: Case report and review of the literature

Management and outcome of spontaneous cervical epidural hematoma: Case report and review of the literature

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

A case of spontaneous spinal epidural hematoma with stroke symptoms

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