A Spontaneous Cervical Epidural Hematoma Mimicking a Stroke: A Challenging Case

Goran Pavlićević; Milan Lepić; Toplica Lepić; Nemanja Jaćimović; Ksenija Radenović; Nenad Novaković; Lukas Rasulić; Stefan Mandić-Rajčević

doi:10.1016/j.jemermed.2019.03.035

A Spontaneous Cervical Epidural Hematoma Mimicking a Stroke: A Challenging Case

J Emerg Med. 2019 Jul;57(1):70-73. doi: 10.1016/j.jemermed.2019.03.035. Epub 2019 May 3.

Authors

Goran Pavlićević¹, Milan Lepić², Toplica Lepić³, Nemanja Jaćimović⁴, Ksenija Radenović⁴, Nenad Novaković⁴, Lukas Rasulić⁵, Stefan Mandić-Rajčević⁶

Affiliations

¹ Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defense, Belgrade, Serbia.
² Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia.
³ Faculty of Medicine of the Military Medical Academy, University of Defense, Belgrade, Serbia; Department of Neurology, Military Medical Academy, Belgrade, Serbia.
⁴ Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia.
⁵ School of Medicine, University of Belgrade, Belgrade, Serbia; Department of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia.
⁶ Innovation Centre of the Faculty of Technology and Metallurgy, University of Belgrade, Belgrade, Serbia.

PMID: 31060847
DOI: 10.1016/j.jemermed.2019.03.035

Abstract

Background: A spontaneous cervical epidural hematoma (SCEH) is a rare occurrence, with < 500 cases reported to date. Clinically, it usually presents with quadriparesis, but in extremely rare cases it can present with hemiparesis or hemiplegia, and can easily be misdiagnosed as stroke. The cervical epidural hematoma by itself is an urgent condition that requires a quick and accurate diagnosis and a prompt surgical treatment.

Case report: We present a case where an SCEH mimicked the much more frequent condition of a stroke, and discuss the importance of diagnostics procedures that help differentiate SCEH from acute cerebral infarction. The patient's history of neck pain and spondylosis render this case more challenging. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Considering that the emergency tissue plasminogen activator treatment for acute cerebral infarction can worsen the state of an SCEH patient, or even lead to permanent damage or death, it is of great importance to rapidly and accurately differentiate these two conditions.

Keywords: hemiparesis; spontaneous cervical epidural hematoma; stroke.

Publication types

Case Reports

MeSH terms

Aged
Female
Hematoma, Epidural, Spinal / complications
Hematoma, Epidural, Spinal / diagnosis*
Hematoma, Epidural, Spinal / diagnostic imaging*
Humans
Muscle Weakness / etiology
Neck Pain / etiology
Rupture, Spontaneous / complications
Rupture, Spontaneous / physiopathology
Stroke / diagnosis
Stroke / physiopathology
Tomography, X-Ray Computed / methods