Two cases of spontaneous cervical epidural hematoma without back or neck pain in elderly Japanese men

Hongo, Takashi; Iseda, Kenichi; Tsuchiya, Midori; Inaba, Masami; Nozaki, Satoshi; Takahashi, Kenji; Nakajima, Michiko; Fujiwara, Toshifumi

doi:10.1002/ams2.317

Cited by 6 publications

(4 citation statements)

References 12 publications

(15 reference statements)

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“…Typically an epidural hematoma is preceded / accompanied by local pain in the spine, [3], [9], [10]. Sometimes spontaneous cervical epidural hematoma is not always an obvious diagnosis [10], because in some elderly patients, back or neck pain might be absent [29]. In our case, the typical sequential evolutive paradigm (characterized by sudden onset with spinal radicular pain, followed by progressive neurological deficits due to spinal cord compression) was absent.…”

Section: Discussionmentioning

confidence: 75%

Acute Spinal Epidural Hematoma, Clinical and Etiopathogenic Diagnostic Difficulties – Case Presentation and Synthesis of the Literature

Anghelescu¹,

Cimpeanu²,

Bajenaru³

et al. 2018

Balneo

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Introduction: Epidural hematoma has a double anatomopathological topography: intracranial and/ or spinal. Its etiology is complex: post-traumatic (spinal trauma, or lumbar puncture), iatrogenic (secondary to an inadequate anticoagulation or antiplatelet treatment), congenital or acquired disorders of coagulation (leukemia, hepatic cirrhosis), secondary to intense Valsalva maneuvers (e.g. during labor, or an intense physical effort), and idiopathic. The purpose of this article is to present a clinical case of acute spinal epidural hematoma (SEDH) with atypical clinical picture and a puzzled pathophysiological mechanism, and also a brief review of the relevant literature. Case presentation: An 80-years-old male patient, with locomotor disability (bilateral congenital foot deformity), and multiple cardiovascular comorbidities (chronic atrial fibrillation (AF), dilated cardiomyopathy and contractile dysfunction (chronic heart failure, with left ventricle ejection fraction 40 %), chronically anticoagulated with a vitamin K antagonist (acenocumarol). The elderly submitted a body-level fall without cranial trauma, event followed by a short loss of consciousness (without convulsions or sphincter relaxation). He suffered a low-energy cervical fracture (C7 vertebral injury) and a posterolateral acute SEDH at C3-Th2 vertebral levels. Decompressive hemilaminectomy at the C4-Th2 levels and evacuation of the SEDH, was performed during the early sub-acute phase. The patient was transferred in our rehabilitation clinic as C4 AIS-C tetraplegia (global motor score 50/100), neurogenic bladder and bowel, with post surgical wound dehiscence (healed per secundam). The subject had a favorable neurological evolution and was discharged as C7 AIS-D tetraplegia (global motor score 81/100). Discussion: The case particularity consists in a puzzled etiopathogenetic mechanisms and difficulty to accurately indicate the chronological chain of events generating the acute SEDH. An overdosed anticoagulant therapy might be incriminated as an iatrogenic cause for a "spontaneous" SEDH, but most probably its etiology is complex, probably traumatic, consequence of the cervical spine fracture due the low-intensity biomechanical impact. The complex predisposing circumstances to accidental fall in our elderly patient were due to the: -impaired, unstable locomotor function, secondary to his bilateral congenital clubfoot deformity / disability -chronic AF, contractile dysfunction and hypodiastolic phenomena, with cardiogenic syncope and global brain ischemia or transient ischemic cerebral attack. Despite the good immediate outcomes, his future functional prognosis might be poor, due to the advanced age, severe cardiovascular pathology and the complex disturbances of the neuro-myo-artro-kinetic apparatus (major impediments of the somatic / body functions and structure). This health-related condition had severe repercussions on the subject`s activity (related to tasks and basic activities of daily living) and participation, affecting the outcome of rehabilitat...

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Section: Discussionmentioning

confidence: 75%

Acute Spinal Epidural Hematoma, Clinical and Etiopathogenic Diagnostic Difficulties – Case Presentation and Synthesis of the Literature

Anghelescu¹,

Cimpeanu²,

Bajenaru³

et al. 2018

Balneo

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“…But the results were quite diverse and different from one patient to another even if they do have the same clinical presentation. Nevertheless, Hongo et al [13] performed hematoma removal and decompression by corpectomy from the front of C3-C5 at approximately 32 h after the onset of symptoms and the patient was able to stand and walk 3 days after the operation without fixation. It may be possible that the extent of recovery does not depend only on the heaviness of the nervous palsy prior to surgery but also on the surgical technique used for the decompression of the dural sheath, nerves, and nerve roots.…”

Section: Discussionmentioning

confidence: 99%

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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“…4 Further complicating the clinical picture of SCEH, Hongo et al described two case reports of elderly Japanese men diagnosed with SCEH who presented with sudden onset of ataxic gait, rather than the more commonly described neck pain and associated progressive neurologic deficits. 10 EPs are often challenged to identify patients with a SCEH who have a presentation that may mimic other, more common diagnoses, such as TIA or acute ischemic stroke. 9,11,12 The misdiagnosis of a SCEH as a TIA or ischemic stroke could lead to the patient receiving antithrombotic medications, which could worsen the hematoma expansion and, ultimately, adversely affect the patient's morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Counselman

Tondt

Lustig

2020

Clinical Practice and Cases in Emergency Medicine

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Introduction: We present the case of a patient with a spontaneous cervical epidural hematoma that presented with neck pain and mild, left arm parasthesia. Case Report: A 59-year old man presented with sudden onset of severe neck pain, without history of injury or trauma. The patient also complained of associated left arm parasthesias that progressed to left arm and leg weakness while in the emergency department. Multiple diagnoses were considered and worked up; eventually the correct diagnosis was made with magnetic resonance imaging of the cervical spine. Conclusion: Spontaneous cervical epidural hematoma typically presents with neck pain, and variable neurologic complaints. This case illustrates the challenge in making this uncommon but serious diagnosis.

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Two cases of spontaneous cervical epidural hematoma without back or neck pain in elderly Japanese men

Cited by 6 publications

References 12 publications

Acute Spinal Epidural Hematoma, Clinical and Etiopathogenic Diagnostic Difficulties – Case Presentation and Synthesis of the Literature

Acute Spinal Epidural Hematoma, Clinical and Etiopathogenic Diagnostic Difficulties – Case Presentation and Synthesis of the Literature

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

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

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