Spontaneous Epidural Hematoma of the Cervical Spine in an Elderly Woman with Recent COVID-19 Infection: A Case Report

Abstract

BACKGROUND This report presents the case of a woman with no known coagulopathy, use of anticoagulants, or history of trauma who spontaneously developed an epidural hematoma of the spine. This is an uncommon condition, with the potential for missed diagnosis and potential harm to the patient. CASE REPORT The patient was an elderly woman with a history of Type 2 diabetes mellitus and hyperlipidemia. Of note, she had recently recovered from COVID-19. Because the woman presented with right-sided weakness and pain in the back of her neck, the stroke team was activated. A computed tomography (CT) scan of her neck revealed a very subtle hyperdensity, which on further investigation was found to be an acute epidural hematoma at C2-C3 space through the C6 vertebra. While awaiting surgery, the patient had spontaneous improvement of her right-sided weakness and her condition eventually was managed conservatively. CONCLUSIONS Spontaneous spinal epidural hematoma is an uncommon condition, and a high index of suspicion is required to accurately diagnose and appropriately manage it. In the case presented here, the hematoma was subtle on the CT scan, and the patient's weakness easily could have been misdiagnosed as an ischemic stroke. That may have resulted in administration of thrombolytics, potentially causing significant harm. In addition, the patient had recently recovered from COVID-19 disease, which may or may not be incidental. Further observation will be required to determine if there is a spike in similar cases, which may be temporally associated with the novel coronavirus.

Figure 1.

Transverse view of non-contrast computed tomography scan of the cervical spine at the C4 vertebra. The image shows subtle hyperdensity (arrows) in the posterior aspect of the spinal canal, which could easily have been missed. This raised suspicion for an acute epidural/subdural hematoma and prompted magnetic resonance imaging.

Figure 2.

Sagittal magnetic resonance image of the cervical spine (T2-weighted). The image shows an acute epidural hematoma (arrows) spanning the C2–C3 space to the C6 vertebra.

Figure 3.

A transverse magnetic resonance image of the C4 vertebra (T2-weighted). The image shows the acute epidural hematoma (arrows). There is associated spinal canal stenosis with spinal cord deviation anteriorly and on the left side.