Case report: a patient with spontaneous spinal epidural hematoma recovered after conservative treatment

Abstract

Spontaneous spinal epidural hematoma is a rare condition, akin to a stroke, which can manifest as hemiplegia. It cannot be diagnosed by head CT scan and is prone to misdiagnosis as a cerebral stroke, potentially leading to the activation of thrombolysis and exacerbation of the condition. This paper reports a case of a patient with this disease, a 68 years-old male who presented with sudden neck pain weakness, and numbness in the left limbs for 2 h. The symptoms were similar to those of a stroke. A head CT scan showed no significant abnormalities, but the clinical presentation of neck pain alerted the physician, who did not hastily administer thrombolysis. Instead, they quickly performed further examinations, including neck vessel ultrasound and neck CT/MRI, to rule out a cerebral stroke. The patient was ultimately diagnosed with spontaneous spinal epidural hematoma in the neck. The patient was transferred to the ICU for conservative treatment, and a follow-up neck MRI the next day revealed a significant reduction in the hematoma, with a corresponding improvement in clinical symptoms. This case report supports the diagnostic value of CT scans for spinal epidural hematoma and shares a conservative treatment plan for patients with high spinal cord lesions.

Keywords: case report; conservative treatment; spontaneous spinal epidural hematoma; stroke; stroke mimic.

FIGURE 1

Bilateral cerebral hemispheres, cerebellum, and diencephalon were symmetrical, with clear boundaries between gray and white matter, and no definite abnormal density shadow was observed in the brain parenchyma definite abnormality was found in the skull bone. The C4–5 segments of bilateral internal carotid arteries were hyperdense. The paranasal sinus mucosa was slightly thickened.

FIGURE 2

On T1 and T2 sequences, an abnormal signal is visible in the epidural space at the posterior part of the spinal canal from C2 to T1, which is suggestive of an epidural hemorrhage, with the spinal cord being compressed and displaced anteriorly and to the right. The red arrow indicates the site of the lesion.

FIGURE 3

A plain computed tomography (CT) scan showed a strip of high-density shadow in the posterior part of the cervical spinal canal, with a CT value of about 71 HU, and the spinal cord was slightly compressed and displaced in the right front. The site of the lesion is indicated by the red arrow.

FIGURE 4

T2 showed a left epidural hematoma at the level of the C3–4 vertebral body, with reduced range and thickness of the lesion. The site of the lesion is indicated by the red arrow.