A case of spontaneous spinal epidural hematoma mimicking a stroke.

Abstract

INTRODUCTION:

For intravenous (IV) thrombolytic therapies to be effective, a correct diagnosis of acute ischemic stroke must be made within 3 hours from the onset of symptoms, a relatively short window period. However, obtaining a diagnosis in the time frame is not easy; a wide variety of conditions mimic a stroke, including seizures, migraine, and even a spinal mass, and often these are diagnosed as acute ischemic stroke and receive thrombolytic therapy.

CASE REPORT:

A patient presented suffering progressive and fluctuating painful triparesis coupled with acute onset dissociated sensory loss. The patient complained of dysarthria and transient altered mentality at the onset of symptoms; therefore, we suspected an ischemic infarction of the brainstem and spinal cord accompanied by vertebral artery dissection. As the time at diagnosis was 2 hours 30 minutes after symptom onset, we started IV thrombolytic treatment using recombinant tissue plasminogen activator. Magnetic resonance imaging during the recombinant tissue plasminogen activator infusion revealed a spontaneous spinal epidural hematoma (SSEH) of the cervical and thoracic spine, leading the patient to undergo an emergency surgery.

CONCLUSIONS:

SSEH is an uncommon clinical condition, and a manifestation of SSEH with anterior spinal artery syndrome is also rare. Furthermore, an emergency operation after IV thrombolytic treatment is an extraordinary situation.

• Authors: Seungnam Son, Dong-Ho Kang, Dae Seob Choi, Soo-Kyoung Kim, Byeong Hoon Lim, Nack-Cheon Choi
• Journal: The neurologist (Neurologist) Vol. 18 Issue 1 Pg. 41-3 (Jan 2012) ISSN: 2331-2637 [Electronic] United States
• PMID: 22217615 (Publication Type: Case Reports, Journal Article)

Chemical References

• Fibrinolytic Agents

Topics

• Diagnosis, Differential
• Fibrinolytic Agents (therapeutic use)
• Hematoma, Epidural, Spinal (diagnosis, surgery)
• Humans
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Stroke (diagnosis, therapy)
• Thrombolytic Therapy (methods)