Atormac
Neurology India
Open access journal indexed with Index Medicus
  Users online: 606  
 Home | Login 
  About Current Issue Archive Ahead of print Search Instructions Online Submission Subscribe Etcetera Contact  
  Navigate Here 
 Search
 
  
 Resource Links
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (621 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this Article
   References
   Article Figures

 Article Access Statistics
    Viewed78    
    Printed3    
    Emailed0    
    PDF Downloaded6    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents    
LETTER TO EDITOR
Year : 2017  |  Volume : 65  |  Issue : 6  |  Page : 1434-1435

Spontaneous spinal epidural hematoma mimicking a cerebrovascular disease


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 Publication10-Nov-2017

Correspondence Address:
Kadir Oktay
Department of Neurosurgery, Mehmet Akif Inan Training and Research Hospital, Sanliurfa
Turkey
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.217978

Rights and Permissions



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

How to cite this URL:
Cetinalp NE, Oktay K, Ozsoy KM. Spontaneous spinal epidural hematoma mimicking a cerebrovascular disease. Neurol India [serial online] 2017 [cited 2017 Nov 21];65:1434-5. Available from: http://www.neurologyindia.com/text.asp?2017/65/6/1434/217978


Sir,

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.[1]

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

Click here to view
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

Click here to view


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.[2] 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.[3] An urgent surgical evacuation of the hematoma is the ideal treatment modality for SSEH.[4],[5]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Groen RJ, van Alphen HA. Operative treatment of spontaneous spinal epidural hematomas: A study of the factors determining postoperative outcome. Neurosurgery 1996;39:494-508.  Back to cited text no. 1
    
2.
Liou KC, Chen LA, Lin YJ. Cervical spinal epidural hematoma mimics acute ischemic stroke. Am J Emerg Med 2012;30:1322.e1-3.  Back to cited text no. 2
    
3.
Liao CC, Hsieh PC, Lin TK, Lin CL, Lo YL, Lee SC. Surgical treatment of spontaneous spinal epidural hematoma: A 5-year experience. J Neurosurg Spine 2009;11:480-6.  Back to cited text no. 3
    
4.
Shin JJ, Kuh SU, Cho YE. Surgical management of spontaneous spinal epidural hematoma. Eur Spine J 2006;15:998-1004.  Back to cited text no. 4
    
5.
Lawton MT, Porter RW, Heiserman JE, Jacobowitz R, Sonntag VK, Dickman CA. Surgical management of spinal epidural hematoma: Relationship between surgical timing and neurological outcome. J Neurosurg 1995;83:1-7.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]



 

Top
Print this article  Email this article
   
Online since 20th March '04
Published by Wolters Kluwer - Medknow