Spontaneous spinal epidural hematoma with hemiparesis mimicking acute cerebral infarction: Two case reports

Authors: Matsumoto, Hiroaki; Miki, Takanori; Miyaji, Yuki; Minami, Hiroaki; Masuda, Atsushi; Tominaga, Shogo; Yoshida, Yasuhisa; Yamaura, Ikuya; Matsumoto, Shigeo; Natsume, Shigeatsu; Yoshida, Kozo

Source: Journal of Spinal Cord Medicine, Volume 35, Number 4, July 2012 , pp. 262-266(5)

Publisher: Maney Publishing

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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.

Keywords: Spontaneous spinal epidural hematoma; Intravenous thrombolytic treatment; Lhermitte's sign; Magnetic resonance imaging; Tetraparesis; Computerized tomography; Alteplase; Hemiparesis; Lhermitte's sign; Cerebral infarction

Document Type: Research Article

DOI: http://dx.doi.org/10.1179/2045772312Y.0000000014

Affiliations: Department of Neurosurgery, Eishokai Yoshida Hospital, Hyogo-ku, Kobe, Japan

Publication date: 2012-07-01

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