title: Misdiagnosis of spontaneous cervical epidural haemorrhage.
abstract: 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.
authors.affiliation: Department of Neurosurgery, Chi-Mei Medical Center, 901 Chung Hwa Road, Yung Kang City, Tainan, Taiwan.
authors.forename: Che-Chuan
authors.initials: CC
authors.lastname: Wang
authors.forename: Chin-Hung
authors.initials: CH
authors.lastname: Chang
authors.forename: Hung-Jung
authors.initials: HJ
authors.lastname: Lin
authors.forename: Kao-Chang
authors.initials: KC
authors.lastname: Lin
authors.forename: Jinn-Rung
authors.initials: JR
authors.lastname: Kuo
mesh_terms: 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