title: Spontaneous spinal epidural hematoma with hemiparesis mimicking acute cerebral infarction: two case reports.
abstract: BACKGROUND
  Acute hemiparesis is a common initial presentation of ischemic stroke. Although hemiparesis due to spontaneous spinal epidural hematoma (SSEH) is an uncommon symptom, a few cases have been reported and misdiagnosed as cerebral infarction.
  
  
  METHODS
  Case  reports of SSEH with acute hemiparesis.
  
  
  RESULTS
  In these two cases, acute stroke was suspected initially and administration of intravenous alteplase therapy was considered. In one case, the presentation was neck pain and in the other case, it was Lhermitte's sign; brain  magnetic resonance imaging (MRI) and magnetic resonance angiography were negative for signs of ischemic infarction, hemorrhage, or arterial dissection. Cervical MRI was performed and demonstrated SSEH.
  
  
  CONCLUSIONS
  Clinicians who perform intravenous thrombolytic treatment  with alteplase need to be aware of this possible contraindication.
authors.affiliation: Department of Neurosurgery, Eishokai Yoshida Hospital, Hyogo-ku, Kobe, Japan. hiroaki-matsu@umin.ac.jp
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Matsumoto
authors.forename: Takanori
authors.initials: T
authors.lastname: Miki
authors.forename: Yuki
authors.initials: Y
authors.lastname: Miyaji
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Minami
authors.forename: Atsushi
authors.initials: A
authors.lastname: Masuda
authors.forename: Shogo
authors.initials: S
authors.lastname: Tominaga
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Yoshida
authors.forename: Ikuya
authors.initials: I
authors.lastname: Yamaura
authors.forename: Shigeo
authors.initials: S
authors.lastname: Matsumoto
authors.forename: Shigeatsu
authors.initials: S
authors.lastname: Natsume
authors.forename: Kozo
authors.initials: K
authors.lastname: Yoshida
mesh_terms: D000368:Aged; D002544:Cerebral Infarction / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D046748:Hematoma, Epidural, Spinal / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010291:Paresis / Q000209:etiology*