Abstract
We report three cases of spontaneous spinal epidural hematoma (SSEH) with hemiparesis. The first patient was a 73-year-old woman who presented with left hemiparesis, neck pain, and left shoulder pain. A cervical MRI scan revealed a left posterolateral epidural hematoma at the C3–C6 level. The condition of the patient improved after laminectomy and evacuation of the epidural hematoma. The second patient was a 62-year-old man who presented with right hemiparesis and neck pain. A cervical MRI scan revealed a right posterolateral dominant epidural hematoma at the C6-T1 level. The condition of the patient improved after laminectomy and evacuation of the epidural hematoma. The third patient was a 60-year-old woman who presented with left hemiparesis and neck pain. A cervical MRI scan revealed a left posterolateral epidural hematoma at the C2–C4 level. The condition of the patient improved with conservative treatment. The classical clinical presentation of SSEH is acute onset of severe irradiating back pain followed by progression to paralysis, whereas SSEH with hemiparesis is less common. Our cases suggest that acute cervical spinal epidural hematoma should be considered as a differential diagnosis in patients presenting with clinical symptoms of sudden neck pain and radicular pain with progression to hemiparesis.
Highlights
Spontaneous spinal epidural hematoma (SSEH) is uncommon, but the number of cases has increased with clarification of the clinical presentation of the condition using radiographic imaging
We report three cases of spontaneous spinal epidural hematoma (SSEH) with hemiparesis, which is uncommon compared to the classical presentation of SSEH as acute onset of severe irradiating back pain followed by paralysis
The patient improved to manual muscle testing (MMT) 3/5, after 2 weeks improved to MMT 4/5 in the left upper and lower extremities, and at the 2-year followup, the patient continued left hemiparesis (MMT 4/5)
Summary
Spontaneous spinal epidural hematoma (SSEH) is uncommon, but the number of cases has increased with clarification of the clinical presentation of the condition using radiographic imaging. We report three cases of SSEH with hemiparesis, which is uncommon compared to the classical presentation of SSEH as acute onset of severe irradiating back pain followed by paralysis. The patient improved to MMT 3/5, after 2 weeks improved to MMT 4/5 in the left upper and lower extremities, and at the 2-year followup, the patient continued left hemiparesis (MMT 4/5). The patient was a 73-year-old woman who experienced acute onset of severe pain in the back of her neck with radiation into her left shoulder. The patient was a 62-year-old man who experienced sudden pain of the posterior cervical region and numbness of the right lower extremity when he bent backward to administer eye drops. An examination showed right hemiparesis (right upper and lower extremities; MMT 2/5) with numbness in the right upper and lower extremities and bladder
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