Misdiagnosis of spontaneous cervical epidural haemorrhage.
Spontaneous spinal epidural haemorrhage is a rare condition. The initial clinical manifestations are variable. Nonetheless, most spinal cord lesions result in paraparesis or quadriparesis, but not hemi-paresis, if motor function is involved. We report on a 69-year-old man who presented initially with right-side limb weakness. He was initially misdiagnosed at emergency room with a cerebral stroke and treated inappropriately with heparin. One day after admission, correct diagnosis of acute spinal epidural haematoma was based on the repeated neurological examination and cervical magnetic resonance imaging study. The patient underwent emergency surgical decompression and hematoma removal. The pathogenesis of the haematoma could have been due to hypertension, increased abdominal pressure and anticoagulant therapy. We emphasize that patients with hemi-paresis on initial presentation could have an acute spinal epidural haemorrhage. We also draw the misdiagnosis to the attention of the reader because early recognition of spontaneous spinal epidural haematoma is very important for prompt and appropriate treatment to improve the overall prognosis.
Wang
Che-Chuan
CC
Department of Neurosurgery, Chi-Mei Medical Center, 901 Chung Hwa Road, Yung Kang City, Tainan, Taiwan.
Chang
Chin-Hung
CH
Lin
Hung-Jung
HJ
Lin
Kao-Chang
KC
Kuo
Jinn-Rung
JR
D000368:Aged; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D046748:Hematoma, Epidural, Spinal / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D008297:Male; D010291:Paresis / Q000175:diagnosis / Q000209:etiology; D020521:Stroke / Q000175:diagnosis*; D016896:Treatment Outcome