Spontaneous spinal epidural hematoma treated with tissue plasminogen activator mimicking ischemic stroke

Chan Hyuk Lee, Kyoung Hyun Kwun, Kun-Hwa Jung

Research output: Contribution to journalArticle

Abstract

Background: Spinal epidural hematoma (EDH) is a rare disease with incidence of 1 per million. Because the disease usually causes paraparesis or tetraparesis, it is not easy to diagnose it as spinal EDH when the patient is presenting with hemiparesis. Case description. A 66-year-old woman presented with a left-sided weakness accompanied by neck pain during an argument. The patient was normal on other neurological examinations including cranial nerve function. Her brain computed tomography (CT) showed no evidence of hemorrhage, so tissue plasminogen activator (tPA) was administered due to suspicion of acute ischemic stroke. Subsequent brain magnetic resonance had no evidence of stroke. We performed cervical spine CT for additional evaluation of neck pain and we diagnosed cervical spinal EDH. Decompressive laminectomy was performed in emergency, and the patient was discharged 4 days after her symptoms improved. Conclusion: Hemiplegic spontaneous cervical EDH occurs very rarely. It is often misdiagnosed as ischemic stroke and is likely to be administered with thrombolytic agents, making the patient's symptoms worse. Early diagnosis and rapid management of cervical EDH increase the likelihood of complete recovery of the patient's symptoms. Therefore, if there are unilateral weakness and neck pain without cranial nerve dysfunction and there is no evidence of stroke in the brain imaging, spinal EDH should be considered.

Original languageEnglish
Article number100569
JournalInterdisciplinary Neurosurgery: Advanced Techniques and Case Management
Volume19
DOIs
StatePublished - 1 Mar 2020

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Spinal Epidural Hematoma
Tissue Plasminogen Activator
Stroke
Neck Pain
Cranial Nerves
Hematoma
Tomography
Paraparesis
Laminectomy
Fibrinolytic Agents
Neurologic Examination
Brain
Paresis
Rare Diseases
Diagnostic Errors
Neuroimaging
Early Diagnosis
Spine
Emergencies
Magnetic Resonance Spectroscopy

Keywords

  • Decompressive laminectomy
  • Hemiparesis
  • Spinal epidural hematoma
  • Stroke mimics
  • Tissue plasminogen activator

Cite this

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title = "Spontaneous spinal epidural hematoma treated with tissue plasminogen activator mimicking ischemic stroke",
abstract = "Background: Spinal epidural hematoma (EDH) is a rare disease with incidence of 1 per million. Because the disease usually causes paraparesis or tetraparesis, it is not easy to diagnose it as spinal EDH when the patient is presenting with hemiparesis. Case description. A 66-year-old woman presented with a left-sided weakness accompanied by neck pain during an argument. The patient was normal on other neurological examinations including cranial nerve function. Her brain computed tomography (CT) showed no evidence of hemorrhage, so tissue plasminogen activator (tPA) was administered due to suspicion of acute ischemic stroke. Subsequent brain magnetic resonance had no evidence of stroke. We performed cervical spine CT for additional evaluation of neck pain and we diagnosed cervical spinal EDH. Decompressive laminectomy was performed in emergency, and the patient was discharged 4 days after her symptoms improved. Conclusion: Hemiplegic spontaneous cervical EDH occurs very rarely. It is often misdiagnosed as ischemic stroke and is likely to be administered with thrombolytic agents, making the patient's symptoms worse. Early diagnosis and rapid management of cervical EDH increase the likelihood of complete recovery of the patient's symptoms. Therefore, if there are unilateral weakness and neck pain without cranial nerve dysfunction and there is no evidence of stroke in the brain imaging, spinal EDH should be considered.",
keywords = "Decompressive laminectomy, Hemiparesis, Spinal epidural hematoma, Stroke mimics, Tissue plasminogen activator",
author = "Lee, {Chan Hyuk} and Kwun, {Kyoung Hyun} and Kun-Hwa Jung",
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N2 - Background: Spinal epidural hematoma (EDH) is a rare disease with incidence of 1 per million. Because the disease usually causes paraparesis or tetraparesis, it is not easy to diagnose it as spinal EDH when the patient is presenting with hemiparesis. Case description. A 66-year-old woman presented with a left-sided weakness accompanied by neck pain during an argument. The patient was normal on other neurological examinations including cranial nerve function. Her brain computed tomography (CT) showed no evidence of hemorrhage, so tissue plasminogen activator (tPA) was administered due to suspicion of acute ischemic stroke. Subsequent brain magnetic resonance had no evidence of stroke. We performed cervical spine CT for additional evaluation of neck pain and we diagnosed cervical spinal EDH. Decompressive laminectomy was performed in emergency, and the patient was discharged 4 days after her symptoms improved. Conclusion: Hemiplegic spontaneous cervical EDH occurs very rarely. It is often misdiagnosed as ischemic stroke and is likely to be administered with thrombolytic agents, making the patient's symptoms worse. Early diagnosis and rapid management of cervical EDH increase the likelihood of complete recovery of the patient's symptoms. Therefore, if there are unilateral weakness and neck pain without cranial nerve dysfunction and there is no evidence of stroke in the brain imaging, spinal EDH should be considered.

AB - Background: Spinal epidural hematoma (EDH) is a rare disease with incidence of 1 per million. Because the disease usually causes paraparesis or tetraparesis, it is not easy to diagnose it as spinal EDH when the patient is presenting with hemiparesis. Case description. A 66-year-old woman presented with a left-sided weakness accompanied by neck pain during an argument. The patient was normal on other neurological examinations including cranial nerve function. Her brain computed tomography (CT) showed no evidence of hemorrhage, so tissue plasminogen activator (tPA) was administered due to suspicion of acute ischemic stroke. Subsequent brain magnetic resonance had no evidence of stroke. We performed cervical spine CT for additional evaluation of neck pain and we diagnosed cervical spinal EDH. Decompressive laminectomy was performed in emergency, and the patient was discharged 4 days after her symptoms improved. Conclusion: Hemiplegic spontaneous cervical EDH occurs very rarely. It is often misdiagnosed as ischemic stroke and is likely to be administered with thrombolytic agents, making the patient's symptoms worse. Early diagnosis and rapid management of cervical EDH increase the likelihood of complete recovery of the patient's symptoms. Therefore, if there are unilateral weakness and neck pain without cranial nerve dysfunction and there is no evidence of stroke in the brain imaging, spinal EDH should be considered.

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