Acute Spontaneous Cervical Epidural Hematoma Mimicking Cerebral Stroke: A Case Report and Literature Review
A 68-year-old female presented with sudden onset posterior neck and right shoulder pain with progressive right side weakness while falling asleep. During consult, she had reported taking anti-hypertensive medication for 20 years and was followed regularly for hepatitis C. She reported no trauma history or physical exertion for the past few weeks. Neurological examination resulted in alert mental status and the detection of right hemiparesis. Motor power of her right upper limb was grade III and ipsilateral hand grasping power was grade II. In her right lower extremity, motor power was grade IV, and her left whole extremities were intact. Right side hypoesthesia was also observed. Based on her medical history and clinical symptoms, the physician working at the emergency department ordered brain CT to rule out intracranial hemorrhage. However, brain CT did not show any positive findings (). Subsequent brain diffuse MRI was taken to rule out cerebral infarction, but it was also negative (). Cervical MRI was performed to rule out a cervical lesion based on the patient's report of posterior neck pain and revealed a mass like lesion in the right posterior epidural space at the C3-6 level compressing the right side of the spinal cord. The mass was isointensive to the spinal cord on T1WI and heterogeneously hyperintensive with central high signal foci on T2WI. At the C5 level, the MRI showed an ovoid, enhancing, nodular lesion, which was a suspected tumorous condition such as hemangioma or hemangiopericytoma (). Initial laboratory tests showed only severe thrombocytopenia (45,000/mm3). As her neurologic signs were getting worse with time, we decided to perform surgical intervention. Under general endotracheal anesthesia via light wand intubation, right C5 unilateral total laminectomy and C6 partial hemilaminectomy were performed. The mass lesion was pure hematoma and was removed (). We could find neither vascular malformation or an active bleeding point. She went into rehabilitation after her operation and finally achieved complete neurologic recovery and relief of neck and shoulder pain.