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Hemiparesis in spontaneous spinal epidural haematoma: a potential stroke imitator
  1. Ravish Patel1,
  2. Aravind Kumar2,
  3. Kazuya Nishizawa1,
  4. Naresh Kumar1
  1. 1Orthopaedic Surgery, National University Hospital, Singapore, Singapore
  2. 2Orthopaedic Surgery, Khoo Teck Puat Hospital, Yishun, Singapore
  1. Correspondence to A/Prof Naresh Kumar, dosksn{at}


Spontaneous spinal epidural haematoma (SSEH) is a rare condition that requires urgent surgical intervention in order to prevent permanent neurological deficit. SSEH commonly presents as a paraparesis or tetraparesis. SSEH presenting as a hemiparesis is less common and in such situations, it can be mistaken for a cerebrovascular accident (CVA). Thrombolytic or anticoagulant treatment for CVA can potentially worsen the neurological deficit. We report one such case of SSEH misdiagnosed as a CVA. Treatment with tissue plasminogen activator led to worsening of his condition. On a subsequent cervical spine MRI, an epidural haematoma extending from C3 to C5 was detected and treated with laminectomy and evacuation. Surgical intervention led to significant improvement from American Spinal Injury Association Scale (ASIA) B to ASIA E. Presence of clinical features such as Horner’s syndrome, Brown-Sequard syndrome and the absence of cranial nerve palsies in acute hemiparesis are indicative of SSEH rather than CVA.

  • stroke
  • spinal cord
  • neurosurgery
  • orthopaedic and trauma surgery
  • warfarin therapy
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  • Contributors RP contributed in planning, reporting, acquisition of data, preparing the manuscript and editing the manuscript. AK played a cardinal role in critically reviewing and editing the manuscript. KN aided in acquisition of data (review of Japanese articles) and in editing the manuscript. NK held a paramount position in conceptualisation, planning and construction of the manuscript.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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