RT Journal Article
SR Electronic
T1 Hemiparesis in spontaneous spinal epidural haematoma: a potential stroke imitator
JF BMJ Case Reports
FD BMJ Publishing Group Ltd
SP bcr-2017-222686
DO 10.1136/bcr-2017-222686
VO 2018
A1 Ravish Patel
A1 Aravind Kumar
A1 Kazuya Nishizawa
A1 Naresh Kumar
YR 2018
UL http://casereports.bmj.com/content/2018/bcr-2017-222686.abstract
AB 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.