Spontaneous Spinal Epidural Hematoma as a Potentially Important Stroke Mimic

Akimoto, Tetsu; Yamada, Takeshi; Shinoda, Souji; Asano, Yoshihide; Nagata, Daisuke

doi:10.4137/jcnsd.s13252

Cited by 28 publications

(34 citation statements)

References 56 publications

(146 reference statements)

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“…Spinal hematomas represent surgical emergencies with earlier intervention portending better outcome [15]. e acute presentation, however, represents an important diagnostic challenge [15] especially as a mimicker of cerebrovascular accidents [18]. Even though no direct trauma is involved in spontaneous spinal hematomas, some activities have been associated with onset such as stretch exercises [19] and Valsalva maneuvers during trumpet playing [20] and defecation [3], for example, which might have been the case in our patient as well.…”

Section: Discussionmentioning

confidence: 60%

Spontaneous Spinal Epidural Hematoma in a Patient on Apixaban for Nonvalvular Atrial Fibrillation

Alayli

Neelakandan

Krayem

2020

Case Reports in Hematology

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Background. With the rise in the use of direct oral anticoagulants (DOACs), more hemorrhagic complications are being encountered. Since the first description of a case of spontaneous spinal epidural hematoma (SSEH) related to the utilization of DOACs in 2012, there have been few reports describing a similar association. However, no cases so far have reported an association between SSEHs and apixaban. Case Description: A 76-year-old lady, with a history of nonvalvular atrial fibrillation, presented with a new onset of progressive left lower and upper extremity weakness. She reported back pain and numbness in the left leg up to the knee along with numbness in the left arm up to the shoulder. A CT scan of the neck was suggestive of an epidural hematoma extending from C2-C3 level to C6-C7. As the patient was on apixaban at the time, surgical treatment was delayed for two days to decrease the risk of intraoperative bleeding. Nine days later, she was discharged. Her physical exam was almost unchanged from that on presentation, except for resolution of pain and minimal improvement in motor power in her left lower extremity from 1/5 to 2/5 distally. Conclusions. Spinal hematomas represent surgical emergencies with earlier intervention portending better outcome. Based on the few case reports that point to DOACs as a potential culprit, it appears that a high suspicion index resulting in earlier SSEH diagnosis and intervention is crucial for improved neurological outcome and recovery. Prompt diagnosis remains a challenge, especially that SSEH can mimic cerebrovascular accidents.

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Section: Discussionmentioning

confidence: 60%

Spontaneous Spinal Epidural Hematoma in a Patient on Apixaban for Nonvalvular Atrial Fibrillation

Alayli

Neelakandan

Krayem

2020

Case Reports in Hematology

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“…However, it is prudent to continue monitoring a patient on thrombolytic therapy and an urgent MRI cervical spine should be sought in those who deteriorate after thrombolysis or who present with atypical features of stroke. A proactive consideration of SSEH as a differential diagnosis for CVA is essential 11. A high index of suspicion, prompt and appropriate investigation and immediate intervention can reduce morbidity when SSEH mimics CVA.…”

Section: Discussionmentioning

confidence: 99%

Hemiparesis in spontaneous spinal epidural haematoma: a potential stroke imitator

et al. 2018

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Spontaneous spinal epidural haematoma (SSEH) is a rare condition that requires urgent surgical intervention in order to prevent permanent neurological deficit. SSEH commonly presents as a paraparesis or tetraparesis. SSEH presenting as a hemiparesis is less common and in such situations, it can be mistaken for a cerebrovascular accident (CVA). Thrombolytic or anticoagulant treatment for CVA can potentially worsen the neurological deficit. We report one such case of SSEH misdiagnosed as a CVA. Treatment with tissue plasminogen activator led to worsening of his condition. On a subsequent cervical spine MRI, an epidural haematoma extending from C3 to C5 was detected and treated with laminectomy and evacuation. Surgical intervention led to significant improvement from American Spinal Injury Association Scale (ASIA) B to ASIA E. Presence of clinical features such as Horner's syndrome, Brown-Sequard syndrome and the absence of cranial nerve palsies in acute hemiparesis are indicative of SSEH rather than CVA.

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“…There were multiple case reports from different parts of the world mostly reported in spine and neurosurgical literature [2][3][4][5], regarding spontaneous epidural hematoma [6]. Our case was different in the sense patient that there was a hematoma around the tumor as seen by the operating neurosurgeon and was removed enblock, further investigations regarding possible metastasis are underway.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2017

JNSK

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We report a case of a 69 year old right handed female, presents to Emergency Room (ER) with sudden onset right hemiparesis, within 90 minutes. She also had nagging neck pain since the start of this weakness. Her examination showed dense right hemiplegia with minimal involvement of face, her initial CT brain was unremarkable. As she was within therapeutic window, was given IV Fibrinolytic therapy. Within three hours, she developed left hemiparesis while her neck pain worsened. Repeat CT brain was unremarkable. Neurologic examination at this stage showed she had quadraparesis with left hemi-sensory loss and new development of right sided horner's syndrome. MRI brain was unremarkable, MRI cervical spine showed spindle shaped extradural mass, likely tumoral hematoma, extending from C2-C6 compressing spinal cord with edema. Neurosurgical evaluation prompted urgent cervical decompression with improvement in her motor function. This case highlights usual presentation with a rarest reason mimicking stroke.

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Spontaneous Spinal Epidural Hematoma as a Potentially Important Stroke Mimic

Cited by 28 publications

References 56 publications

Spontaneous Spinal Epidural Hematoma in a Patient on Apixaban for Nonvalvular Atrial Fibrillation

Spontaneous Spinal Epidural Hematoma in a Patient on Apixaban for Nonvalvular Atrial Fibrillation

Hemiparesis in spontaneous spinal epidural haematoma: a potential stroke imitator

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