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Khandelwal A, Kakati A, Ali A. Cervical epidural hematoma masquerading as thrombosis of intracranial flow diverter in situ: A diagnostic and therapeutic conundrum. Med J Armed Forces India 2024; 80:98-101. [PMID: 38261807 PMCID: PMC10793230 DOI: 10.1016/j.mjafi.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/21/2022] [Indexed: 02/10/2023] Open
Abstract
Cervical epidural hematoma (EDH) is a rare but very serious cause of acute neurologic compression that needs early diagnosis and rapid intervention. Acute hemiparesis is an infrequent presentation of cervical EDH and often mimics cerebrovascular accident. In this case, we describe the management of a case of cervical EDH presenting as acute hemiparesis in an elderly female patient which mimicked as thrombosis of intracranial flow diverter in situ. The report emphasizes that cervical EDH should be considered as differential diagnosis in patients who present with acute hemiparesis especially, who are on antiplatelets or anticoagulants. Also, in a patient considered high-risk for surgery, conservative management can be considered under close supervision and intensive monitoring, especially, in non-expanding hematoma and non-progressive neurological deterioration.
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Affiliation(s)
- Ankur Khandelwal
- Associate Professor (Anaesthesiology, Critical Care & Pain Medicine), All India Institute of Medical Sciences (AIIMS), Guwahati, Assam, India
| | - Arindom Kakati
- Senior Neurosurgeon (Neurosciences), Hayat Superspeciality Hospital, Guwahati, Assam, India
| | - Asman Ali
- Associate Professor (Neurosurgery), Guwahati Medical College and Hospital (GMCH), Guwahati, Assam, India
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2
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Ohno H, Fujishiro T, Hayama S, Mizutani M, Moriuchi H, Fujita A, Neo M. Spontaneous Cervical Epidural Hematoma Presenting with Respiratory Failure: A Case Report and Literature Review. JBJS Case Connect 2023; 13:01709767-202309000-00063. [PMID: 37616442 DOI: 10.2106/jbjs.cc.23.00246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
CASE A 62-year-old woman who had an unremarkable medical history presented with sudden headache and neck pain. After the presentation, complete quadriplegia and respiratory arrest developed, and the patient was urgently intubated. Magnetic resonance imaging revealed an extensive epidural hematoma (EH), and emergency hematoma evacuation was performed. At the 1-year follow-up visit, the patient had no motor deficits. CONCLUSION We reported a case of spontaneous cervical EH presenting with respiratory failure that was successfully treated with surgical management. Literature review has shown that the surgical outcome is very poor; nevertheless, prompt surgical decompression of the spinal cord can minimize neurological sequelae.
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Affiliation(s)
- Hiroaki Ohno
- Department of Orthopedic Surgery, First Towakai Hospital, Takatsuki, Japan
| | - Takashi Fujishiro
- Department of Orthopedic Surgery, First Towakai Hospital, Takatsuki, Japan
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Sachio Hayama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Masahiro Mizutani
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Hiromitsu Moriuchi
- Department of Orthopedic Surgery, First Towakai Hospital, Takatsuki, Japan
| | - Akifumi Fujita
- Department of Orthopedic Surgery, First Towakai Hospital, Takatsuki, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
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3
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Na XBM, Khoo SMK. Stroke-like manifestation of a spontaneous spinal epidural hematoma with spontaneous resolution: a case report. Int J Emerg Med 2023; 16:10. [PMID: 36803212 PMCID: PMC9940068 DOI: 10.1186/s12245-023-00478-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/17/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND This case report presents the case of a man with no known coagulopathy or preceding trauma, who spontaneously developed a spinal epidural hematoma (SEH). This is an uncommon condition which can have variable presentations including hemiparesis mimicking stroke, resulting in the potential for misdiagnosis and inappropriate treatment. CASE PRESENTATION A 28-year-old Chinese male with no past medical history presented with sudden onset neck pain associated with bilateral upper limbs and right lower limb subjective numbness but intact motor function. He was discharged after adequate pain relief but re-attended the emergency department with right hemiparesis. A magnetic resonance imaging of his spine revealed an acute cervical spinal epidural hematoma at C5 and C6. While admitted, he had spontaneous improvement of his neurological function and was eventually managed conservatively. CONCLUSIONS SEH, although uncommon, can be a mimic of stroke and it is important to avoid misdiagnosis as it is a time critical diagnosis, and administration of thrombolysis or antiplatelets can lead to unfavourable outcomes. Having a high clinical suspicion can help to guide us in the choice of imaging and interpretation of subtle signs to reach the correct diagnosis in a timely manner. Further research is required to better understand the factors that would favour a conservative approach as opposed to surgical treatment.
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Affiliation(s)
- Xue Bi, May Na
- Emergency Department, Khoo Teck Puat Hospital, National Healthcare Group, 90 Yishun Central, Singapore, 768828 Singapore
| | - Swee Min, Kathleen Khoo
- Emergency Department, Khoo Teck Puat Hospital, National Healthcare Group, 90 Yishun Central, Singapore, 768828 Singapore
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4
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Vastani A, Baig Mirza A, Khoja AK, Bartram J, Shaheen S, Rajkumar S, China M, Lavrador JP, Bleil C, Bell D, Thomas N, Malik I, Grahovac G. Prognostic factors and surgical outcomes of spontaneous spinal epidural haematoma: a systematic review and meta-analysis. Neurosurg Rev 2022; 46:21. [PMID: 36538111 DOI: 10.1007/s10143-022-01914-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
Spontaneous spinal epidural haematoma (SSEH) is a rare disease defined as blood accumulation within the vertebral epidural space without a cause identified, which can lead to severe neurological deficits. We aim to provide a comprehensive understanding of the prognostic factors affecting surgical outcomes in true SSEH and propose a critical time frame for operative management. A systematic literature search was performed and registered, using OVID Medline and EMBASE, in line with the PRISMA guidelines. Relevant demographic, clinical, surgical, and outcome data were extracted. The ASIA scale was uniformly used throughout our systematic review. Statistical analysis was performed via logistic regression. Of the 1179 articles examined, we included 181 studies involving 295 adult patients surgically treated for SSEH. SSEH were most commonly found in the cervicothoracic spine, with 2-4 spinal segments most commonly involved. Multivariable logistic regression model showed that the following factors were statistically significant in the post-operative outcome: operation type (P = 0.024), pre-operative neurologic status (P < 0.001), use of warfarin (P = 0.039), and operative interval (P = 0.006). Our retrospective analysis confirms the reversibility of severe neurological deficits after surgical intervention, with a prognosis of post-operative outcomes determined by the use of warfarin, pre-operative ASIA grade, and above all surgical evacuation within 12 h.
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Affiliation(s)
- Amisha Vastani
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK.
| | - Asfand Baig Mirza
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Abbas Khizar Khoja
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - James Bartram
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Safwan Shaheen
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Shivani Rajkumar
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Musa China
- Division of Medicine, University College London (UCL), London, UK
| | - Jose Pedro Lavrador
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Cristina Bleil
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - David Bell
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Nick Thomas
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Irfan Malik
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Gordan Grahovac
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
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Zhou LL, Zhu SG, Fang Y, Huang SS, Huang JF, Hu ZD, Chen JY, Zhang X, Wang JY. Neck pain and absence of cranial nerve symptom are clues of cervical myelopathy mimicking stroke: Two case reports. World J Clin Cases 2022; 10:11835-11844. [PMID: 36405285 PMCID: PMC9669878 DOI: 10.12998/wjcc.v10.i32.11835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/27/2022] [Accepted: 08/25/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cervical myelopathy is a potential stroke imitator, for which intravenous thrombolysis would be catastrophic.
CASE SUMMARY We herein present two cases of cervical myelopathy. The first patient presented with acute onset of right hemiparesis and urinary incontinence, and the second patient presented with sudden-onset right leg monoplegia. The initial diagnoses for both of them were ischemic stroke. However, both of them lacked cranial nerve symptom and suffered neck pain at the beginning of onset. Their cervical spinal cord lesions were finally confirmed by cervical computed tomography. A literature review showed that neck pain and absence of cranial nerve symptom are clues of cervical myelopathy.
CONCLUSION The current report and the review remind us to pay more attention to these two clues in suspected stroke patients, especially those within the thrombolytic time window.
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Affiliation(s)
- Li-Li Zhou
- Institute of Geriatric Neurology, Department of Neurology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Shi-Guo Zhu
- Institute of Geriatric Neurology, Department of Neurology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Yuan Fang
- Institute of Geriatric Neurology, Department of Neurology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Shi-Shi Huang
- Institute of Geriatric Neurology, Department of Neurology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Jie-Fan Huang
- Institute of Geriatric Neurology, Department of Neurology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Ze-Di Hu
- Institute of Geriatric Neurology, Department of Neurology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Jin-Yu Chen
- Institute of Geriatric Neurology, Department of Neurology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Xiong Zhang
- Institute of Geriatric Neurology, Department of Neurology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Jian-Yong Wang
- Institute of Geriatric Neurology, Department of Neurology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
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SAĞLIK A, ŞENCAN F, GİRAY TA, OCAK T. Non-traumatic Spontaneous Spinal Subdural Hematoma in a Patient with Acute Paraplegia. JOURNAL OF EMERGENCY MEDICINE CASE REPORTS 2022. [DOI: 10.33706/jemcr.1080366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Acute non-traumatic spinal subdural hematoma (SSDH) is a rare clinical condition in the emergency medicine practice and difficult to diagnose during the primary physical examination. It mostly occurs at thoracal vertebra levels due to trauma, use of anticoagulants, medical procedures such as acupuncture, arteriovenous malformations, hematological disorders or space-occupying lesions. Here, we discussed an elderly female patient who was not on anticoagulant and described sudden loss of muscle strength and sensation in both lower extremities. Initial laboratory and imaging including brain computerized tomography (CT) and magnetic resonance imaging (MRI) were in normal range. Her secondary examination revealed anesthesia under the T4 dermatome level. Cervical spine-MRI imaging revealed a subdural hematoma significantly compressing the spinal cord on the C7-T1 dermatome segments. Any emergency neurosurgical intervention was not considered and the patient was interned in the neurosurgical clinic for conservative treatment and further examination. Patient , with no progress seen in consecutive MRI scans, was discharged after offering an outpatient check-up. We recommend secondary physical examination in emergency department (ED). In the case of appearance of sensory deficits of certain dermatomes, spine-MR imaging may lead to put the diagnose early in ED.
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7
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Huang CT, Lin CH, Wang HP, Lien WC. Spontaneous cervical epidural hematoma in a patient with end-stage renal disease. Hemodial Int 2021; 26:E5-E7. [PMID: 34227217 DOI: 10.1111/hdi.12970] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/26/2021] [Indexed: 11/28/2022]
Abstract
Spontaneous spinal epidural hematoma (SEH) is extremely rare in patients with end-stage renal disease (ESRD). We report a case of a 71-year-old man with ESRD presented with progressive left limb weakness. Magnetic resonance imaging (MRI) revealed spinal cervical SEH involving C3-5 level. The patient received emergent decompression laminectomy with the evacuation of the epidural hematoma.
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Affiliation(s)
- Chien-Tai Huang
- Department of Emergency Medicine, National Taiwan University, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Hao Lin
- Department of Emergency Medicine, National Taiwan University, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University, National Taiwan University Hospital, Taipei, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University, National Taiwan University Hospital, Taipei, Taiwan
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8
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Teles P, Correia JP, Pappamikail L, Lourenço A, Romero C, Lopes F, Almeida GN, Abreu P. A spontaneous cervical epidural hematoma mimicking a stroke - A case report. Surg Neurol Int 2020; 11:157. [PMID: 32637210 PMCID: PMC7332487 DOI: 10.25259/sni_161_2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/27/2020] [Indexed: 01/30/2023] Open
Abstract
Background: A spontaneous cervical epidural hematoma (SCEH) is a rare occurrence. It usually presents with quadriparesis, but it may present with hemiparesis or hemiplegia and can easily be misdiagnosed as stroke. We present a case of stroke mimicking SCEH with hemiparesis worsened after tissue plasminogen activator therapy (tPA) followed by emergency cervical decompression laminectomy. Case Description: A 63-year-old female presented to the emergency department with sudden onset of posterior neck and left shoulder pain with the right side hemiparesis. On neurological examination, the patient had motor power of the right upper and lower limb of 2/5 Medical Research Council, and her whole left extremities were intact. Her medical history was unremarkable for trauma, hemorrhagic diathesis, or anticoagulation therapy. A head computed tomography was ordered ruling out intracranial hemorrhage. Assuming an acute ischemic stroke as the most likely diagnosis, alteplase (tPA) was administered 3 h after symptoms onset, however without any improvement in patient symptoms. A cervical magnetic resonance was performed revealing a right paramedian epidural mass-like lesion between C3-C6. The patient underwent cervical laminectomy C3-C6 with evacuation of epidural hematoma with significant clinical status improvement after surgery. Conclusion: tPA treatment is frequently used as first-line therapy for acute ischemic stroke. Therefore, physicians should be aware of the potential for the SCEH in patients presenting with hemiparesis, as tPA administration may increase cervical hematoma leading to clinical deterioration. With this case, we intended to warn about SCEH as a rare but possible entity, since its early recognition and prompt clinical intervention may improve neurological outcomes.
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Affiliation(s)
- Pedro Teles
- Department of Neurosurgery, Centro Hospitalar Universitario do Algarve, Rua Leao Penedo, Faro, Portugal
| | - Joaquim Pedro Correia
- Department of Neurosurgery, Centro Hospitalar Universitario do Algarve, Rua Leao Penedo, Faro, Portugal
| | - Lia Pappamikail
- Department of Neurosurgery, Centro Hospitalar Universitario do Algarve, Rua Leao Penedo, Faro, Portugal
| | - Artur Lourenço
- Department of Neurosurgery, Centro Hospitalar Universitario do Algarve, Rua Leao Penedo, Faro, Portugal
| | - Clara Romero
- Department of Neurosurgery, Centro Hospitalar Universitario do Algarve, Rua Leao Penedo, Faro, Portugal
| | - Fátima Lopes
- Department of Neurosurgery, Centro Hospitalar Universitario do Algarve, Rua Leao Penedo, Faro, Portugal
| | - Gonçalo Neto Almeida
- Department of Neurosurgery, Centro Hospitalar Universitario do Algarve, Rua Leao Penedo, Faro, Portugal
| | - Pedro Abreu
- Department of Neurosurgery, Centro Hospitalar Universitario do Algarve, Rua Leao Penedo, Faro, Portugal
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Patel R, Kumar A, Nishizawa K, Kumar N. Hemiparesis in spontaneous spinal epidural haematoma: a potential stroke imitator. BMJ Case Rep 2018; 2018:bcr-2017-222686. [PMID: 29374642 DOI: 10.1136/bcr-2017-222686] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
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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Affiliation(s)
- Ravish Patel
- Orthopaedic Surgery, National University Hospital, Singapore, Singapore
| | - Aravind Kumar
- Orthopaedic Surgery, Khoo Teck Puat Hospital, Yishun, Singapore
| | - Kazuya Nishizawa
- Orthopaedic Surgery, National University Hospital, Singapore, Singapore
| | - Naresh Kumar
- Orthopaedic Surgery, National University Hospital, Singapore, Singapore
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10
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Perez JC, Crespo M, Velez C, Caceres J. Inpatient rehabilitation following operative spontaneous spinal epidural hematoma mimicking stroke: a case report. Spinal Cord Ser Cases 2017; 2:16007. [PMID: 28053751 DOI: 10.1038/scsandc.2016.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 03/16/2016] [Accepted: 04/12/2016] [Indexed: 11/09/2022] Open
Abstract
Spontaneous spinal epidural hematoma (SSEH) is a rare cause of spinal cord compression. Symptoms may include sudden-onset axial pain followed by neurologic involvement including weakness, numbness and incontinence. Here we report the case of a patient followed prospectively after surgical intervention following SSEH and recovery following inpatient rehabilitation. This patient presented with right hemiplegia, neurogenic bladder and bowel with autonomic dysfunction. the patient with significant gains in Functional Independence Measure scale that improved from 15 on admission to 35 1 month following surgery. This case suggests that treating this type of patients requires hospitals specialized in spinal cord injury.
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Affiliation(s)
- Juan C Perez
- Department of Physical Medicine and Rehabilitation, University District Hospital, University of Puerto Rico School of Medicine , San Juan, Puerto Rico
| | - Myriam Crespo
- Department of Physical Medicine and Rehabilitation, University District Hospital, University of Puerto Rico School of Medicine , San Juan, Puerto Rico
| | - Candido Velez
- Department of Physical Medicine and Rehabilitation, University District Hospital, University of Puerto Rico School of Medicine , San Juan, Puerto Rico
| | - Jorge Caceres
- Department of Physical Medicine and Rehabilitation, University District Hospital, University of Puerto Rico School of Medicine , San Juan, Puerto Rico
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11
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Lan T, Chen Y, Yang XJ, Hu SY, Guo WZ, Ren K, Qian WB, Yang ZY. Spontaneous spinal epidural haematoma. J Orthop Translat 2015; 3:152-156. [PMID: 30035052 PMCID: PMC5982392 DOI: 10.1016/j.jot.2015.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 02/13/2015] [Accepted: 03/05/2015] [Indexed: 01/30/2023] Open
Abstract
Spontaneous spinal epidural haematoma (SSEH) is a rare clinical condition with unknown aetiology. Prompt diagnosis and treatment are paramount because of the risk of permanent neurological deficits without appropriate intervention. We described a case of a 48-year-old man presenting with complete quadriplegia and hypoesthesia. Magnetic resonance imaging revealed cervical cord compression due to a haematoma posterior to the spinal cord. Surgical decompression and evacuation of the haematoma was performed within 12 hours after admission to the authors' hospital. Both the patient's motor and sensory functions recovered soon after the operation. Early surgical decompression for SSEH with neurologic impairment is therefore recommended for the recovery of this patient and also serves as a relevant reference for orthopaedic clinics. Foundation number: CXZZ20140414170821148.
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Affiliation(s)
- Tao Lan
- Department of Orthopaedics, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Yang Chen
- Department of Orthopaedics, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Xin-Jian Yang
- Department of Orthopaedics, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Shi-Yu Hu
- Department of Orthopaedics, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Wei-Zhuang Guo
- Department of Orthopaedics, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Kai Ren
- Department of Orthopaedics, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Wen-Bin Qian
- Department of Orthopaedics, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Ze-Yu Yang
- Department of Orthopaedics, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
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12
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Buyukgol H, Ilik MK, Ilik F. Ischemic stroke differential diagnose: spontaneous spinal epidural hematoma can be fatal. Am J Emerg Med 2015; 33:1112.e1-2. [PMID: 25748286 DOI: 10.1016/j.ajem.2015.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 01/14/2015] [Indexed: 10/24/2022] Open
Affiliation(s)
- Huseyin Buyukgol
- Department of Neurology, Aksaray State Hospital, Aksaray, Turkey.
| | - M Kemal Ilik
- Mevlana University Department of Neurosurgery, Konya, Turkey
| | - Faik Ilik
- Mevlana University Department of Neurology, Konya, Turkey
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13
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Hara N, Otonari T, Nishihara N, Ota T, Kuriyama M. [Clinical manifestations of 16 patients with spontaneous spinal epidural hematoma -stroke mimic and pitfalls for diagnosis]. Rinsho Shinkeigaku 2014; 54:395-402. [PMID: 24943075 DOI: 10.5692/clinicalneurol.54.395] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Clinical manifestations of 16 patients with spontaneous spinal epidural hematoma were presented. We examined the point similar to that of stroke. During the initial visit of our hospital, the patients showed the hemiplegia in 10 cases (62.5%), Horner syndrome in 4 cases (25%), the painless onset in 1 case (6.3%). And one case showed the impairment of consciousness due to vagal reflex in severe pain onset, which was similar to those of subarachnoid hemorrhage. MRI images are useful to confirm the diagnosis. The frequent site of hematoma was the lower cervical spinal cord. The oval shaped hematomas shifted to the left or right in spinal canals, compressed spinal cords in axial image, which was a cause of hemiplegia. Many cases developed during active periods, and the hemorrhage might be relevant to oral antithrombotic agent, C hepatitis, and chronic renal failure. Rapidly progressive cases were indications for emergency surgery, but conservative therapy is also possible and was better prognosis.
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Affiliation(s)
- Naoyuki Hara
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
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14
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15
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Estaitieh N, Alam S, Sawaya R. Atypical presentations of spontaneous spinal epidural hematomas. Clin Neurol Neurosurg 2014; 122:135-6. [PMID: 24810163 DOI: 10.1016/j.clineuro.2013.12.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 12/09/2013] [Accepted: 12/25/2013] [Indexed: 12/14/2022]
Affiliation(s)
- N Estaitieh
- Department of Neurology, American University Medical Center, Beirut, Lebanon
| | - S Alam
- Division of Cardiology, Department of Internal Medicine, American University Medical Center, Beirut, Lebanon
| | - R Sawaya
- Department of Neurology, American University Medical Center, Beirut, Lebanon.
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16
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Akimoto T, Yamada T, Shinoda S, Asano Y, Nagata D. Spontaneous spinal epidural hematoma as a potentially important stroke mimic. J Cent Nerv Syst Dis 2014; 6:15-20. [PMID: 24526842 PMCID: PMC3921023 DOI: 10.4137/jcnsd.s13252] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 12/05/2013] [Accepted: 12/14/2013] [Indexed: 11/18/2022] Open
Abstract
Hemiparesis develops in response to a wide range of neurological disorders, such as stroke, neoplasms and several inflammatory processes. Occasionally, it may also occur due to a lesion located in the high cervical spinal cord. In this concise review, we describe the features of spontaneous spinal epidural hematoma, which should be included in the large list of stroke mimics. Various concerns regarding the diagnostic and therapeutic conundrums relating to the condition are also discussed.
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Affiliation(s)
- Tetsu Akimoto
- Department of Internal Medicine, Koga Red Cross Hospital, Koga, Japan. ; Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Takeshi Yamada
- Department of Neurosurgery, Koga Red Cross Hospital, Koga, Japan
| | - Soji Shinoda
- Department of Neurosurgery, Koga Red Cross Hospital, Koga, Japan
| | - Yasushi Asano
- Department of Internal Medicine, Koga Red Cross Hospital, Koga, Japan
| | - Daisuke Nagata
- Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
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Acute spinal subdural hematoma with hemiplegia after acupuncture: a case report and review of the literature. Spine J 2013; 13:e59-63. [PMID: 24094991 DOI: 10.1016/j.spinee.2013.06.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 03/13/2013] [Accepted: 06/01/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Subdural spinal hematoma (SDH) is a very rare entity; however, it can lead to serious complications resulting from injuries to the spinal cord and roots. Although acupuncture has been a popular method for the management of pain control, we encountered the first case of SDH after acupuncture. PURPOSE The purpose of this case report was to present the first case of subdural hematoma after acupuncture and the reasons for the risks of blind cervical acupuncture. STUDY DESIGN A case report and review of the previous literature are presented. METHODS A 69-year-old man complained of progressive weakness in the right upper and lower extremities 2 hours after acupuncture on the cervical spine and back. The diagnosis was delayed because of unilateral weakness, and the symptom was initially misinterpreted as a transient ischemic attack because of no sensory change and pain and normal findings of two brain magnetic resonance imaging (MRI). RESULTS Cervical MRI 36 hours after onset revealed acute hematoma from the C3-C5 level; hematoma showed an isointensity on T1-weighted image (WI) with the preservation of epidural fat and a hypointensity on T2WI. A decompressive surgery was scheduled to perform within 2 days after the cervical MRI scan because of a previous anticoagulation therapy, but the patient refused it. Finally, 9 days after the onset, surgical decompression and removal of hematoma were performed. Three months postoperatively, the patient had fully recovered demonstrating fine hand movement and good ability to walk up and down the stairs. CONCLUSIONS Our study indicates that it is essential to perform cervical MRI when a patient does not show an improvement in the neurologic deficit and has a negative brain MRI after acupuncture. In addition, blind acupuncture if not correctly practiced may be harmful to the cervical structures.
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Kim JK, Kim TH, Park SK, Hwang YS, Shin HS, Shin JJ. Acute spontaneous cervical epidural hematoma mimicking cerebral stroke: a case report and literature review. KOREAN JOURNAL OF SPINE 2013; 10:170-3. [PMID: 24757481 PMCID: PMC3941760 DOI: 10.14245/kjs.2013.10.3.170] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 08/25/2013] [Accepted: 08/27/2013] [Indexed: 11/19/2022]
Abstract
Spontaneous cervical epidural hematoma (SCEDH) is a rare disease, but can cause severe neurologic impairment. We report a case of a 68-year-old female who presented with sudden onset, posterior neck pain, right shoulder pain, and progressive right hemiparesis mimicking stroke with no trauma history. Initial brain CT and diffusion MRI performed to rule out brain lesion did not show any positive findings. Laboratory examination presented only severe thrombocytopenia (45,000/mm3). Subsequent cervical MRI revealed a cervical epidural mass lesion. We confirmed that it was pure hematoma through C5 unilateral total laminectomy and C6 partial hemilaminectomy. She achieved complete neurologic recovery with active rehabilitation. Early surgical decompression for SCEDH with neurologic impairment should be recommended for better outcome.
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Affiliation(s)
- Jin Kyu Kim
- Department of Neurosurgery, Sanggye-Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Tae Hong Kim
- Department of Neurosurgery, Sanggye-Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Sang Keun Park
- Department of Neurosurgery, Sanggye-Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Yong Soon Hwang
- Department of Neurosurgery, Sanggye-Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Hyung Shik Shin
- Department of Neurosurgery, Sanggye-Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jun Jae Shin
- Department of Neurosurgery, Sanggye-Paik Hospital, Inje University College of Medicine, Seoul, Korea
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19
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Kim T, Lee CH, Hyun SJ, Yoon SH, Kim KJ, Kim HJ. Clinical Outcomes of Spontaneous Spinal Epidural Hematoma : A Comparative Study between Conservative and Surgical Treatment. J Korean Neurosurg Soc 2012; 52:523-7. [PMID: 23346323 PMCID: PMC3550419 DOI: 10.3340/jkns.2012.52.6.523] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 09/07/2012] [Accepted: 12/18/2012] [Indexed: 12/17/2022] Open
Abstract
Objective The incidence of spontaneous spinal epidural hematoma (SSEH) is rare. Patients with SSEH, however, present disabling neurologic deficits. Clinical outcomes are variable among patients. To evaluate the adequate treatment method according to initial patients' neurological status and clinical outcome with comparison of variables affecting the clinical outcome. Methods We included 15 patients suffered from SSEH. Patients were divided into two groups by treatment method. Initial neurological status and clinical outcomes were assessed by the American Spinal Injury Association (ASIA) impairment scale. Also sagittal hematoma location and length of involved segment was analyzed with magnetic resonance images. Other factors such as age, sex, premorbid medication and duration of hospital stay were reviewed with medical records. Nonparametric statistical analysis and subgroup analysis were performed to overcome small sample size. Results Among fifteen patients, ten patients underwent decompressive surgery, and remaining five were treated with conservative therapy. Patients showed no different initial neurologic status between treatment groups. Initial neurologic status was strongly associated with neurological recovery (p=0.030). Factors that did not seem to affect clinical outcomes included : age, sex, length of the involved spinal segment, sagittal location of hematoma, premorbid medication of antiplatelets or anticoagulants, and treatment methods. Conclusion For the management of SSEH, early decompressive surgery is usually recommended. However, conservative management can also be feasible in selective patients who present neurologic status as ASIA scale E or in whom early recovery of function has initiated with ASIA scale C or D.
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Affiliation(s)
- Tackeun Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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20
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Lemmens R, Ceuppens J, Wilms G, Depreitere B. Transient hemiparesis caused by spontaneous cervical epidural hematoma. Acta Neurol Belg 2012; 112:291-3. [PMID: 22565778 DOI: 10.1007/s13760-012-0079-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 04/23/2012] [Indexed: 01/30/2023]
Abstract
Spontaneous cervical epidural hematoma (SCEH) is rare and can result in various clinical phenotypes. Transient focal neurological symptoms, which have not yet been reported on, can result in overlooking this differential diagnosis in patients presenting with passing neurological deficits and assuming the diagnosis of a transient ischemic attack. Therefore, a thorough documentation of patient history is of importance, since this can reveal symptoms suggestive of a different etiology. Here, we present a case of a 66-year-old female who was admitted with a hemiparesis without cortical or cranial neurological abnormalities. When asked for preceding symptoms like headache or neck ache she mentioned interscapular pain. Imaging of the cervical spine showed an epidural hematoma. Symptoms resolved spontaneously over 24 h without surgical intervention. Our case illustrates the variation in the clinical presentation of SCEH which can result in transient symptoms, even without surgical intervention. Therefore, in patients with transient focal neurological deficits this diagnosis should be included in the differential, particularly when cortical and cranial signs are lacking.
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21
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Liou KC, Chen LA, Lin YJ. Cervical spinal epidural hematoma mimics acute ischemic stroke. Am J Emerg Med 2012; 30:1322.e1-3. [DOI: 10.1016/j.ajem.2011.06.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 06/04/2011] [Indexed: 12/29/2022] Open
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22
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Matsumoto H, Miki T, Miyaji Y, Minami H, Masuda A, Tominaga S, Yoshida Y, Yamaura I, Matsumoto S, Natsume S, Yoshida K. Spontaneous spinal epidural hematoma with hemiparesis mimicking acute cerebral infarction: two case reports. J Spinal Cord Med 2012; 35:262-6. [PMID: 22925753 PMCID: PMC3425883 DOI: 10.1179/2045772312y.0000000014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
CONTEXT Acute hemiparesis is a common initial presentation of ischemic stroke. Although hemiparesis due to spontaneous spinal epidural hematoma (SSEH) is an uncommon symptom, a few cases have been reported and misdiagnosed as cerebral infarction. DESIGN Case reports of SSEH with acute hemiparesis. FINDINGS In these two cases, acute stroke was suspected initially and administration of intravenous alteplase therapy was considered. In one case, the presentation was neck pain and in the other case, it was Lhermitte's sign; brain magnetic resonance imaging (MRI) and magnetic resonance angiography were negative for signs of ischemic infarction, hemorrhage, or arterial dissection. Cervical MRI was performed and demonstrated SSEH. CONCLUSION Clinicians who perform intravenous thrombolytic treatment with alteplase need to be aware of this possible contraindication.
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Affiliation(s)
- Hiroaki Matsumoto
- Department of Neurosurgery, Eishokai Yoshida Hospital, Hyogo-ku, Kobe, Japan.
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23
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Qiu W, Sun W, Guo C, Wu Z, Ding M, Shen H. Diagnosis and microsurgery of symptomatic spontaneous spinal epidural hematoma. Ir J Med Sci 2010; 180:241-5. [PMID: 20680702 DOI: 10.1007/s11845-010-0533-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Accepted: 07/08/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND Symptomatic spontaneous spinal epidural hematoma (SSEH) is an uncommon cause of cord compression that needs emergent treatment. Without effective management of the symptomatic SSEH, irreversible severe spinal injury would be possible. OBJECTIVES We aimed to investigate the diagnosis and surgical management of symptomatic SSEH. METHODS Five cases of symptomatic SSEH with favorable neurological recovery after emergent microsurgery were prospectively analysed. RESULTS The main clinical presentations were root pain and palsy. The main manifestations of MRI were long-segment epidural lesions of high intensity on T1- and T2-weighted images without enhancement. Laminectomy via posterior approach and hematoma removal were undergone for all patients. All patients achieved full neurological recovery without complications. CONCLUSIONS MRI manifestation assisted with the main clinical symptoms may aid the preoperative diagnosis of SSEH, and the delay in obtaining preoperative Digital subtraction angiography is worthwhile, especially for those with progressive neurological deterioration.
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Affiliation(s)
- W Qiu
- Department of Neurosurgery, Hangzhou Second Hospital, College of Medicine, Hangzhou Normal University, Hangzhou, 310015, China
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24
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Dimou J, Jithoo R, Bush S. A patient with delayed traumatic cervical spinal epidural haematoma presenting with hemiparesis. J Clin Neurosci 2010; 17:404-5. [DOI: 10.1016/j.jocn.2009.02.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Accepted: 02/22/2009] [Indexed: 01/30/2023]
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25
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Dimou J, Jithoo R, Morokoff A. Spontaneous spinal epidural haematoma in a geriatric patient on aspirin. J Clin Neurosci 2010; 17:142-4. [DOI: 10.1016/j.jocn.2009.03.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Accepted: 03/11/2009] [Indexed: 01/28/2023]
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26
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Spontaneous spinal epidural hematoma: An urgent complication of adding clopidogrel to aspirin therapy. J Neurol Sci 2009; 285:254-6. [DOI: 10.1016/j.jns.2009.06.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 06/11/2009] [Accepted: 06/12/2009] [Indexed: 11/20/2022]
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27
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Oh SH, Han IB, Koo YH, Kim OJ. Acute spinal subdural hematoma presenting with spontaneously resolving hemiplegia. J Korean Neurosurg Soc 2009; 45:390-3. [PMID: 19609426 DOI: 10.3340/jkns.2009.45.6.390] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Accepted: 05/18/2009] [Indexed: 11/27/2022] Open
Abstract
Although prompt diagnosis and emergent surgical intervention are important in acute spinal subdural hematoma (SSDH), some cases with spontaneous remission of symptom and hematoma without surgery have been reported. We present a case of acute nontraumatic SSDH presenting with transient left hemiplegia for 4 hours. A magnetic resonance imaging study of cervical spine confirmed SSDH with C3-6 cervical cord compression at the left side. The patient had conservative management without recurrence. Although hemiplegia is an unusual clinical manifestation of SSDH, it should be differentiated from that of cerebrovascular origin promptly. Conservative management may be an alternative therapeutic option for selective cases with transient neurological deficits.
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Affiliation(s)
- Seung-Hun Oh
- Department of Neurology, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Korea
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28
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Kato Y, Takeda H, Furuya D, Deguchi I, Tanahashi N. Spontaneous spinal epidural hematoma with unusual hemiparesis alternating from one side to the other side. Intern Med 2009; 48:1703-5. [PMID: 19755779 DOI: 10.2169/internalmedicine.48.2493] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 59-year-old woman suffered from sudden onset of severe neck and back pain. She experienced right-side hemiparesis. Although the right-side hemiparesis soon disappeared, left-side hemiparesis developed. MRI of the brain was unremarkable. MRI of the cervical spine demonstrated hematoma in the left posterior epidural space at the C2/3 level. The spinal cord was compressed not only by a degenerative disc of the ventral region, but also by hematomas of the dorsal region. The unusual hemiparesis alternating from right-side to left-side in this case may have been caused by various factors, including cervical canal stenosis, the spread of hematoma, disturbance of blood flow, and distribution of stress and strain.
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Affiliation(s)
- Yuji Kato
- Department of Neurology and Cerebrovascular Medicine, Saitama International Medical Center, Saitama Medical University, Saitama, Japan.
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29
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Wang CC, Chang CH, Lin HJ, Lin KC, Kuo JR. Misdiagnosis of spontaneous cervical epidural haemorrhage. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2008; 18 Suppl 2:210-2. [PMID: 19005691 DOI: 10.1007/s00586-008-0819-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Revised: 09/01/2008] [Accepted: 10/17/2008] [Indexed: 01/30/2023]
Abstract
Spontaneous spinal epidural haemorrhage is a rare condition. The initial clinical manifestations are variable. Nonetheless, most spinal cord lesions result in paraparesis or quadriparesis, but not hemi-paresis, if motor function is involved. We report on a 69-year-old man who presented initially with right-side limb weakness. He was initially misdiagnosed at emergency room with a cerebral stroke and treated inappropriately with heparin. One day after admission, correct diagnosis of acute spinal epidural haematoma was based on the repeated neurological examination and cervical magnetic resonance imaging study. The patient underwent emergency surgical decompression and hematoma removal. The pathogenesis of the haematoma could have been due to hypertension, increased abdominal pressure and anticoagulant therapy. We emphasize that patients with hemi-paresis on initial presentation could have an acute spinal epidural haemorrhage. We also draw the misdiagnosis to the attention of the reader because early recognition of spontaneous spinal epidural haematoma is very important for prompt and appropriate treatment to improve the overall prognosis.
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Affiliation(s)
- Che-Chuan Wang
- Department of Neurosurgery, Chi-Mei Medical Center, 901 Chung Hwa Road, Yung Kang City, Tainan, Taiwan
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30
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High blood pressure and the spontaneous spinal epidural hematoma: the misconception about their correlation. Eur J Emerg Med 2008; 15:119-20. [DOI: 10.1097/mej.0b013e328285d6e8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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31
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Spengos K, Tsivgoulis G, Zakopoulos N. Could high blood pressure be the cause of acute spontaneous spinal epidural hematoma? Eur J Emerg Med 2007; 14:59. [PMID: 17198332 DOI: 10.1097/01.mej.0000224434.82117.47] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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