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|LETTER TO EDITOR
|Year : 2017 | Volume
| Issue : 6 | Page : 1434-1435
Spontaneous spinal epidural hematoma mimicking a cerebrovascular disease
Nuri E Cetinalp1, Kadir Oktay2, Kerem M Ozsoy1
1 Department of Neurosurgery, Cukurova University School of Medicine, Adana, Turkey
2 Department of Neurosurgery, Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey
|Date of Web Publication||10-Nov-2017|
Department of Neurosurgery, Mehmet Akif Inan Training and Research Hospital, Sanliurfa
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Cetinalp NE, Oktay K, Ozsoy KM. Spontaneous spinal epidural hematoma mimicking a cerebrovascular disease. Neurol India 2017;65:1434-5
Spontaneous spinal epidural hematoma (SSEH) manifests like a space-occupying lesion in the spinal canal and usually occurs without the presence of any known etiological factors such as major trauma, tumor, or vascular pathology. It is a rare but emergent entity in neurosurgical practice. It can mimic other cerebral or cervical pathologies, particularly cerebrovascular diseases, because of the similarity of symptoms in the two conditions. This pathology should be kept in mind to prevent permenant neurologic sequelae in these patients.
A 62-year old woman presented to our emergency department with sudden-onset, severe headache, neck pain and left-sided weakness. She had a history of coronary artery disease and hypertension, and was being administered acetylsalicylic acid. She had no prior history of head or neck trauma. Her neurological examination revealed that she was conscious, well-oriented and cooperative, and her cranial nerves were intact. She had a left-sided hemiplegia, reduced vibration – position sensation ipsilaterally, and reduced pain - temperature sensation contralaterally below the C4 level. Bilateral deep tendon reflexes were exaggerated and left-sided Babinski's sign was present. Her computed tomographic (CT) image did not reveal any obvious pathology. Cerebral and spinal magnetic resonance imaging (MRI) were also performed. The brain MRI was within normal limits, but the spinal MRI revealed an epidural hematoma between C3 and T5 levels [Figure 1]. She was diagnosed with a mild impairement of her bleeding parameters based upon her blood tests, due to the acetylsalicylic acid medication that she was being administered. After administration of fresh frozen plasma, pulse prednisolone, and platelet transfusion, she underwent an emergent operation within four hours of the onset of her symptoms. As the thickest part of the hematoma was located at the C5 level, a hemilaminectomy was planned at that level. A left-sided C5 hemilaminectomy and hematoma evacuation were performed. The postoperative course was uneventful and postoperative spinal MRI showed complete resolution of the hematoma [Figure 2]. Her weakness and complaints improved on the second day after the surgery. She was discharged on the fifth postoperative day. She started walking on her own. She had no recurrent or new complaints at a 3-year follow-up.
|Figure 1: (a) Sagital and (b) axial spinal T2-weighted MRI scans reveal an epidural hematoma between the C3 and T5 levels|
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|Figure 2: (a) Sagital T1-weighted; and, (b) axial T2-weighted MRI scans reveal complete resolution of the spinal compression following surgical evacuation\of the SSEH|
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The most common symptoms of SSEH are acute-onset severe neck or back pain and motor, sensory, and/or sphincteric deficits, depending on the level of the hematoma. Severe headache may be detectable in some patients, as was the initial presentation in this case. In high cervical lesions, SSEH may cause spinal shock and may be potentially fatal. Due to the presence of sudden severe headache with backache, these patients may be erroneously diagnosed to be suffering from a cerebrovascular disease such as subarachnoid hemorrhage. In the absence of cerebral symptoms such as deterioration in consciousness and cranial nerve deficits, SSEH should be kept in mind by the treating physician because the medications administered for treating cerebrovascular diseases may often be contraindicated in the presence of SSEH. MRI of the spine is the gold standard diagnostic technique for SSEH. In the early period of the hematoma formation, SSEH is detected as an iso- or hypointense lesion on T1-weighted images and a hyperintense lesion on T2-weighted images. An urgent surgical evacuation of the hematoma is the ideal treatment modality for SSEH.,
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[Figure 1], [Figure 2]