Spontaneous Spinal Epidural Hematoma Mimicking Stroke and Its Outcome post Intravenous Thrombolysis

Background and Purpose: Spontaneous spinal epidural hematoma (SSEH) is a rare neurological emergency. Its presentation, depending on location of hematoma, could mimic stroke. While intravenous thrombolysis (IVT) is recommended to commence as early as possible in case of acute ischemic stroke, it is likely that it could be given to SSEH patients. We aimed to examine the prevalence, outcome, and prognosis of such patients. Methods: We have retrospectively screened all patients given IVT from January 2008 to March 2021 admitted to United Christian Hospital, a tertiary hospital in Hong Kong. We reviewed the final diagnosis of all patients and included cases diagnosed with SSEH. Their clinical and radiological features, treatment, and outcome were analyzed. We further performed a literature review to search for all cases with SSEH given IVT and review their clinical features and outcome. Results: Out of a total of 940 patients over the 12-year span, 2 patients were diagnosed with SSEH, accounting for 0.21% of cases. From our literature search, to date, there are only 10 cases that had been reported from 5 case reports where IVT was given to SSEH patients. Of the 12 cases, all presented with hemiparesis and 9 with pain. Of those with neck pain, 3 with initial computed tomography angiogram done showed SSEH which was missed initially. Eight were treated surgically and 4 conservatively. All recovered with no major disability. Conclusions: Though a rare disease, awareness toward SSEH presenting as stroke mimic should be raised.

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Spontaneous Spinal Epidural Hematoma as a Potentially Important Stroke Mimic

Journal of Central Nervous System Disease ◽

10.4137/jcnsd.s13252 ◽

2014 ◽

Vol 6 ◽

pp. JCNSD.S13252 ◽

Cited By ~ 12

Author(s):

Tetsu Akimoto ◽

Takeshi Yamada ◽

Soji Shinoda ◽

Yasushi Asano ◽

Daisuke Nagata

Keyword(s):

Epidural Hematoma ◽

Cervical Spinal Cord ◽

Spinal Epidural Hematoma ◽

Spontaneous Spinal Epidural Hematoma ◽

Concise Review ◽

Wide Range ◽

Inflammatory Processes ◽

Stroke Mimic ◽

High Cervical ◽

Spinal Epidural

Hemiparesis develops in response to a wide range of neurological disorders, such as stroke, neoplasms and several inflammatory processes. Occasionally, it may also occur due to a lesion located in the high cervical spinal cord. In this concise review, we describe the features of spontaneous spinal epidural hematoma, which should be included in the large list of stroke mimics. Various concerns regarding the diagnostic and therapeutic conundrums relating to the condition are also discussed.

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Clinical manifestations of 16 patients with spontaneous spinal epidural hematoma —Stroke mimic and pitfalls for diagnosis—

Rinsho Shinkeigaku ◽

10.5692/clinicalneurol.54.395 ◽

2014 ◽

Vol 54 (5) ◽

pp. 395-402 ◽

Cited By ~ 1

Author(s):

Naoyuki Hara ◽

Tatsuya Otonari ◽

Nobuharu Nishihara ◽

Taisei Ota ◽

Masaru Kuriyama

Keyword(s):

Epidural Hematoma ◽

Clinical Manifestations ◽

Spinal Epidural Hematoma ◽

Spontaneous Spinal Epidural Hematoma ◽

Stroke Mimic ◽

Spinal Epidural

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Spontaneous spinal epidural hematoma with hemiparesis mimicking acute cerebral infarction: Two case reports

Journal of Spinal Cord Medicine ◽

10.1179/2045772312y.0000000014 ◽

2012 ◽

Vol 35 (4) ◽

pp. 262-266 ◽

Cited By ~ 18

Author(s):

Hiroaki Matsumoto ◽

Takanori Miki ◽

Yuki Miyaji ◽

Hiroaki Minami ◽

Atsushi Masuda ◽

...

Keyword(s):

Cerebral Infarction ◽

Epidural Hematoma ◽

Case Reports ◽

Acute Cerebral Infarction ◽

Spinal Epidural Hematoma ◽

Spontaneous Spinal Epidural Hematoma ◽

Spinal Epidural

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Spontaneous Spinal Epidural Hematoma in a Patient on Apixaban for Nonvalvular Atrial Fibrillation

Case Reports in Hematology ◽

10.1155/2020/7419050 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Ahmad El Alayli ◽

Logeswari Neelakandan ◽

Hicham Krayem

Keyword(s):

Atrial Fibrillation ◽

Epidural Hematoma ◽

Case Reports ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Spinal Epidural Hematoma ◽

Nonvalvular Atrial Fibrillation ◽

Spontaneous Spinal Epidural Hematoma ◽

Left Lower Extremity ◽

Spinal Epidural

Background. With the rise in the use of direct oral anticoagulants (DOACs), more hemorrhagic complications are being encountered. Since the first description of a case of spontaneous spinal epidural hematoma (SSEH) related to the utilization of DOACs in 2012, there have been few reports describing a similar association. However, no cases so far have reported an association between SSEHs and apixaban. Case Description: A 76-year-old lady, with a history of nonvalvular atrial fibrillation, presented with a new onset of progressive left lower and upper extremity weakness. She reported back pain and numbness in the left leg up to the knee along with numbness in the left arm up to the shoulder. A CT scan of the neck was suggestive of an epidural hematoma extending from C2-C3 level to C6-C7. As the patient was on apixaban at the time, surgical treatment was delayed for two days to decrease the risk of intraoperative bleeding. Nine days later, she was discharged. Her physical exam was almost unchanged from that on presentation, except for resolution of pain and minimal improvement in motor power in her left lower extremity from 1/5 to 2/5 distally. Conclusions. Spinal hematomas represent surgical emergencies with earlier intervention portending better outcome. Based on the few case reports that point to DOACs as a potential culprit, it appears that a high suspicion index resulting in earlier SSEH diagnosis and intervention is crucial for improved neurological outcome and recovery. Prompt diagnosis remains a challenge, especially that SSEH can mimic cerebrovascular accidents.

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