Spontaneous Cervical Epidural Hematoma Mimicking Stroke: A New Perspective on Diagnosis and Treatment
ABSTRACT
Objective: The authors report an extremely rare case of stroke-mimicking, spontaneous cervical epidural hematoma treated with tissue plasminogen activator (TPA). Case Report: We report the case of a 69-year-old female presenting with left-sided hemiparesis of the arm and leg. She was administered by TPA because she was thought to have an ischemic stroke and intracranial CT showed no hemorrhage. However, her neurological condition continued to decline, and MRI of her cervical spine revealed a large spontaneous epidural hematoma. Subsequently, the patient underwent emergency surgery. Conclusions: TPA administration to spinal epidural hematoma (SEH) patients is dangerous. Because cervical epidural hematomas can mimic stroke, the attending medical staff needs to exercise vigilance in diagnosis. In addition to the head, the spine should also be scanned prior to TPA administration.
Objective: The authors report an extremely rare case of stroke-mimicking, spontaneous cervical epidural hematoma treated with tissue plasminogen activator (TPA). Case Report: We report the case of a 69-year-old female presenting with left-sided hemiparesis of the arm and leg. She was administered by TPA because she was thought to have an ischemic stroke and intracranial CT showed no hemorrhage. However, her neurological condition continued to decline, and MRI of her cervical spine revealed a large spontaneous epidural hematoma. Subsequently, the patient underwent emergency surgery. Conclusions: TPA administration to spinal epidural hematoma (SEH) patients is dangerous. Because cervical epidural hematomas can mimic stroke, the attending medical staff needs to exercise vigilance in diagnosis. In addition to the head, the spine should also be scanned prior to TPA administration.
KEYWORDS
Tissue Plasminogen Activator (TPA); Stroke Mimic; Spontaneous Spinal Epidural Hematoma; Cervical
Tissue Plasminogen Activator (TPA); Stroke Mimic; Spontaneous Spinal Epidural Hematoma; Cervical
Cite this paper
A. Yurter and P. E. Kaloostian, "Spontaneous Cervical Epidural Hematoma Mimicking Stroke: A New Perspective on Diagnosis and Treatment," Open Journal of Modern Neurosurgery, Vol. 3 No. 4, 2013, pp. 59-62. doi: 10.4236/ojmn.2013.34013.
A. Yurter and P. E. Kaloostian, "Spontaneous Cervical Epidural Hematoma Mimicking Stroke: A New Perspective on Diagnosis and Treatment," Open Journal of Modern Neurosurgery, Vol. 3 No. 4, 2013, pp. 59-62. doi: 10.4236/ojmn.2013.34013.
References
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[1] S. Son, D. H. Kang, D. S. Choi, S. K. Kim, B. H. Lim and N. C. Choi, “A Case of Spontaneous Spinal Epidural Hematoma Mimicking a Stroke,” Neurologist, Vol. 18, No. 1, 2012, pp. 41-43. http://dx.doi.org/10.1097/NRL.0b013e31823d7ade [2] J. W. Schmidley, S. Mallenbaum and K. Broyles, “Spinal Epidural Hematoma: An Important Stroke Mimic,” Acute Medicine, Vol. 12, No. 1, 2013, pp. 30-33. [3] K. C. Liou, L. A. Chen and Y. J. Lin, “Cervical Spinal Epidural Hematoma Mimics Acute Ischemic Stroke,” American Journal of Emergency Medicine, Vol. 30, No. 7, 2012, pp. 1322.e1-1322.e3. [4] T. Abe, Y. Nagamine, S. Ishimatsu and Y. Tokuda, “Spinal Epidural Hematoma after Stretch Exercise: A Case Report,” American Journal of Emergency Medicine, Vol. 27, No. 7, 2009, pp. 902.e1-902.e2. [5] C. L. Chen, C. H. Lu and N. F. Chen, “Spontaneous Spinal Epidural Hematoma Presenting with Quadriplegia after Sit-Ups Exercise,” American Journal of Emergency Medicine, Vol. 27, No. 9, 2009, pp. 1170.e3-1170.e7. [6] J. Dimou, R. Jithoo and S. Bush, “A Patient with Delayed Traumatic Cervical Spinal Epidural Haematoma Presenting with Hemiparesis,” Journal of Clinical Neuroscience, Vol. 17, No. 3, 2010, pp. 404-405. http://dx.doi.org/10.1016/j.jocn.2009.02.030 [7] S. Lidder, K. J. Lang, S. Masterson and S. Blagg, “Acute Spinal Epidural Haematoma Causing Cord Compression after Chiropractic Neck Manipulation: An Under-Recognised Serious Hazard?” Journal of the Royal Army Medical Corps, Vol. 156, No. 4, 2010, pp. 255-257. http://dx.doi.org/10.1136/jramc-156-04-11 [8] A. M. Vitali and P. Steinbok, “Spontaneous Spinal Epidural Hematoma Following Weight Lifting,” Canadian Journal of Neurological Sciences, Vol. 35, No. 2, 2008, pp. 262-264. [9] Z. Liu, Q. Jiao, J. Xu, X. Wang, S. Li and C. You, “Spontaneous Spinal Epidural Hematoma: Analysis of 23 Cases,” Surgical Neurology, Vol. 69, No. 3, 2008, pp. 253-260. http://dx.doi.org/10.1016/j.surneu.2007.02.019 [10] J. Duffill, O. C. Sparrow, J. Millar and C. S. Barker, “Can Spontaneous Spinal Epidural Haematoma Be Managed Safely without Operation? A Report of Four Cases,” Journal of Neurology, Neurosurgery & Psychiatry, Vol. 69, No. 6, 2000, pp. 816-819. http://dx.doi.org/10.1136/jnnp.69.6.816 [11] M. T. Lawton, R. W. Porter, J. E. Heiserman, R. Jacobowitz, V. K. Sonntag and C. A. Dickman, “Surgical Management of Spinal Epidural Hematoma: Relationship between Surgical Timing and Neurological Outcome,” Journal of Neurosurgery, Vol. 83, No. 1, 1995, pp. 1-7. http://dx.doi.org/10.3171/jns.1995.83.1.0001 [12] J. J. Shin, S. U. Kuh and Y. E. Cho, “Surgical Management of Spontaneous Spinal Epidural Hematoma,” European Spine Journal, Vol. 15, No. 6, 2006, pp. 998-1004. http://dx.doi.org/10.1007/s00586-005-0965-8 [13] R. J. Groen and H. A. van Alphen, “Operative Treatment of Spontaneous Spinal Epidural Hematomas: A Study of the Factors Determining Postoperative Outcome,” Neurosurgery, Vol. 39, No. 3, 1996, pp. 494-508.