A case of spontaneous spinal epidural hematoma mimicking a stroke.
BACKGROUND
For intravenous (IV) thrombolytic therapies to be effective, a correct diagnosis of acute ischemic stroke must be made within 3 hours from the onset of symptoms, a relatively short window period. However, obtaining a diagnosis in the time frame is not easy; a wide variety of conditions mimic a stroke, including seizures, migraine, and even a spinal mass, and often these are diagnosed as acute ischemic stroke and receive thrombolytic therapy.


METHODS
A patient presented suffering progressive and fluctuating painful triparesis coupled with acute onset dissociated sensory loss. The patient complained of dysarthria and transient altered mentality at the onset of symptoms; therefore, we suspected an ischemic infarction of the brainstem and spinal cord accompanied by vertebral artery dissection. As the time at diagnosis was 2 hours 30 minutes after symptom onset, we started IV thrombolytic treatment using recombinant tissue plasminogen activator. Magnetic resonance imaging during the recombinant tissue plasminogen activator infusion revealed a spontaneous spinal epidural hematoma (SSEH) of the cervical and thoracic spine, leading the patient to undergo an emergency surgery.


CONCLUSIONS
SSEH is an uncommon clinical condition, and a manifestation of SSEH with anterior spinal artery syndrome is also rare. Furthermore, an emergency operation after IV thrombolytic treatment is an extraordinary situation.
Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Korea.
Seungnam
S
Son
Dong-Ho
DH
Kang
Dae Seob
DS
Choi
Soo-Kyoung
SK
Kim
Byeong Hoon
BH
Lim
Nack-Cheon
NC
Choi
D003937:Diagnosis, Differential; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D046748:Hematoma, Epidural, Spinal / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000175:diagnosis* / Q000628:therapy; D015912:Thrombolytic Therapy / Q000379:methods
D005343:Fibrinolytic Agents