A case of spontaneous spinal epidural hematoma that mimicked acute cerebral ischemic stroke and was treated by a recombinant tissue-type plasminogen activator

Eijiro Okada, Morio Matsumoto, Koota Watanabe, Mitsuru Yagi, Ken Ninomiya, Yukio Horiuchi, Yoshiaki Toyama

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Summary: A healthy 49-year-old female complaining of progressive hemiplegia of the left side consulted the Emergency Department. Neurological examinations and non-contrast computed tomography of the brain showed no evidence of hemorrhage. Acute ischemic stroke was diagnosed, and intravenous recombinant tissue-type plasminogen activator was administered under the guidelines of the National Institute of Neurological Disorders. After starting the treatment, the patient developed progressive quadriplegia and pain in the back of her neck. Cervical magnetic resonance imaging showed a vast epidural hematoma. The patient underwent emergency decompression surgery and removal of the hematoma by spine surgeons. Intraoperative epidural bleeding was observed on the left side at the C3-C4 level. Postoperatively, the patient showed significant improvement, becoming neurologically intact and functional by the 14-month follow-up. Importantly, this case illustrates that a cervical epidural hematoma can present as hemiplegia, which can be misdiagnosed as a cerebrovascular accident in neurology emergency rooms.

Original languageEnglish
Pages (from-to)99-101
Number of pages3
JournalNeurosurgery Quarterly
Volume22
Issue number2
DOIs
Publication statusPublished - 2012 May

Fingerprint

Spinal Epidural Hematoma
Tissue Plasminogen Activator
Hematoma
Hemiplegia
Stroke
Hospital Emergency Service
Hemorrhage
Quadriplegia
Neurologic Examination
Back Pain
Neurology
Decompression
Nervous System Diseases
Diagnostic Errors
Spine
Emergencies
Neck
Tomography
Magnetic Resonance Imaging
Guidelines

Keywords

  • cervical spine
  • differential diagnosis
  • hemiplegia
  • recombinant tissue-type plasminogen activator (rtPA)
  • spinal epidural hematoma

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

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abstract = "Summary: A healthy 49-year-old female complaining of progressive hemiplegia of the left side consulted the Emergency Department. Neurological examinations and non-contrast computed tomography of the brain showed no evidence of hemorrhage. Acute ischemic stroke was diagnosed, and intravenous recombinant tissue-type plasminogen activator was administered under the guidelines of the National Institute of Neurological Disorders. After starting the treatment, the patient developed progressive quadriplegia and pain in the back of her neck. Cervical magnetic resonance imaging showed a vast epidural hematoma. The patient underwent emergency decompression surgery and removal of the hematoma by spine surgeons. Intraoperative epidural bleeding was observed on the left side at the C3-C4 level. Postoperatively, the patient showed significant improvement, becoming neurologically intact and functional by the 14-month follow-up. Importantly, this case illustrates that a cervical epidural hematoma can present as hemiplegia, which can be misdiagnosed as a cerebrovascular accident in neurology emergency rooms.",
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AU - Okada, Eijiro

AU - Matsumoto, Morio

AU - Watanabe, Koota

AU - Yagi, Mitsuru

AU - Ninomiya, Ken

AU - Horiuchi, Yukio

AU - Toyama, Yoshiaki

PY - 2012/5

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N2 - Summary: A healthy 49-year-old female complaining of progressive hemiplegia of the left side consulted the Emergency Department. Neurological examinations and non-contrast computed tomography of the brain showed no evidence of hemorrhage. Acute ischemic stroke was diagnosed, and intravenous recombinant tissue-type plasminogen activator was administered under the guidelines of the National Institute of Neurological Disorders. After starting the treatment, the patient developed progressive quadriplegia and pain in the back of her neck. Cervical magnetic resonance imaging showed a vast epidural hematoma. The patient underwent emergency decompression surgery and removal of the hematoma by spine surgeons. Intraoperative epidural bleeding was observed on the left side at the C3-C4 level. Postoperatively, the patient showed significant improvement, becoming neurologically intact and functional by the 14-month follow-up. Importantly, this case illustrates that a cervical epidural hematoma can present as hemiplegia, which can be misdiagnosed as a cerebrovascular accident in neurology emergency rooms.

AB - Summary: A healthy 49-year-old female complaining of progressive hemiplegia of the left side consulted the Emergency Department. Neurological examinations and non-contrast computed tomography of the brain showed no evidence of hemorrhage. Acute ischemic stroke was diagnosed, and intravenous recombinant tissue-type plasminogen activator was administered under the guidelines of the National Institute of Neurological Disorders. After starting the treatment, the patient developed progressive quadriplegia and pain in the back of her neck. Cervical magnetic resonance imaging showed a vast epidural hematoma. The patient underwent emergency decompression surgery and removal of the hematoma by spine surgeons. Intraoperative epidural bleeding was observed on the left side at the C3-C4 level. Postoperatively, the patient showed significant improvement, becoming neurologically intact and functional by the 14-month follow-up. Importantly, this case illustrates that a cervical epidural hematoma can present as hemiplegia, which can be misdiagnosed as a cerebrovascular accident in neurology emergency rooms.

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KW - differential diagnosis

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KW - recombinant tissue-type plasminogen activator (rtPA)

KW - spinal epidural hematoma

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