Background: Spontaneous spinal epidural hematoma (SSEH) is a rare spinal cord disorder requiring urgent diagnosis and prompt treatment to prevent irreversible neurological damage. Subarachnoid hemorrhage (SAH), usually presenting with headache and neck stiffness, is also a worldwide neurosurgical emergency. In this case study, a patient on clopidogrel presented with an SSEH mimicking a spontaneous SAH.
Case description: A 74-year-old female presented with severe headache and neck pain which ultimately attributed to a cervicothoracic SSEH resulting in cord compression. Notably, there was a long delay in establishing the diagnosis of SSEH as her symptoms mimicked a SAH. Although the patient ultimately underwent spinal surgery followed by intense rehabilitation, the diagnostic delay resulted in a poor neurological outcome.
Conclusions: Patients with spontaneous cervicothoracic epidural hematomas may occasionally present with symptoms of severe headache and neck pain/stiffness mimicking an SAH. Long diagnostic delays in establishing SSEH may result in irreversible cord damage.
Keywords: Clopidogrel; magnetic resonance imaging; spinal epidural hematoma; subarachnoid hemorrhage.