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KMID : 0388720210280040141
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Journal of Korean Society of Spine Surgery
2021 Volume.28 No. 4 p.141 ~ p.146
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Spontaneous Cervical Spinal Epidural Hematoma Mimicking Acute Ischemic Stroke: A Case Report
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Song Sang-Youn
Lee Eun-Chang
Kim Dong-Chul
Kim Dong-Hee
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Abstract
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Study Design: Case report.
Objectives: To report a case of spontaneous spinal epidural hematoma (SSEH) mimicking acute ischemic stroke in an 80-year-old woman.
Summary of Literature Review: SSEH is a rare condition. Its initial presentation can vary, but generally involves neck pain, headache, gait disorder, and quadriplegia. These initial symptoms are sometimes mistaken for acute ischemic stroke or spontaneous spinal subdural hematoma. SSEH mimicking acute ischemic stroke or spontaneous spinal subdural hematoma is unique.
Materials and Methods: An 80-year-old woman was referred to our center with symptoms of headache and left-side hemiparesis (motor grade 1/5). After 2 hours, the neurologic deficit spontaneously improved (3/5). The neurology department initially diagnosed the patient with acute ischemic stroke and began treatment with anticoagulants. Cervical magnetic resonance imaging (MRI) demonstrated that the diagnosis was spinal subdural hematoma, presenting with acute hematoma at the level of C2-3.
Results: Decompression surgery was performed for hematoma, and pathologic findings confirmed it to be SSEH. One month after the operation, the patient's motor strength recovered to a normal level.
Conclusions: SSEH is difficult to diagnose because its initial clinical presentation mimics that of acute ischemic stroke. Therefore, medical staff should first suspect SSEH, rather than acute ischemic stroke and transient ischemic stroke, in cases of hemiparesis accompanied by pain. Cervical MRI is a standard diagnostic tool for spinal hematoma. However, differentiation between epidural and subdural hematoma is sometimes difficult. Therefore, if the patient's neurological symptoms do not improve despite conservative treatment, surgical decompression should be performed for diagnostic and therapeutic purposes.
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KEYWORD
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Spinal epidural hematoma, Ischemic stroke, Spinal subdural hematoma, Decompression surgery, Magnetic resonance imaging
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