Abstract
Objective: The authors report an extremely rare case of stroke-mimicking, spontaneous cervical epidural hematoma treated with tissue plasminogen activator (TPA). Case Report: We report the case of a 69-year-old female presenting with left-sided hemiparesis of the arm and leg. She was administered by TPA because she was thought to have an ischemic stroke and intracranial CT showed no hemorrhage. However, her neurological condition continued to decline, and MRI of her cervical spine revealed a large spontaneous epidural hematoma. Subsequently, the patient underwent emergency surgery. Conclusions: TPA administration to spinal epidural hematoma (SEH) patients is dangerous. Because cervical epidural hematomas can mimic stroke, the attending medical staff needs to exercise vigilance in diagnosis. In addition to the head, the spine should also be scanned prior to TPA administration.
Highlights
For intravenous thrombolytic therapies to be effective, a correct diagnosis of acute ischemic stroke must be made within a 3 hour window from symptom onset [1]
The authors report an extremely rare case of stroke-mimicking, spontaneous cervical epidural hematoma treated with tissue plasminogen activator (TPA)
Case Report: We report the case of a 69-year-old female presenting with left-sided hemiparesis of the arm and leg
Summary
For intravenous thrombolytic therapies to be effective, a correct diagnosis of acute ischemic stroke must be made within a 3 hour window from symptom onset [1]. Due to the difficulty in obtaining a diagnosis in the relatively short span, it is occasionally given to patients whose stroke-like symptoms manifest from other pathologies, such as epilepsy, migraine, or psychogenic illness [2]. While patients with suspected intracranial hemorrhage are excluded from TPA intervention, spinal hemorrhage is not ruled out using any image modality This is problematic because a spinal epidural hematoma (SEH) can compress the spinal cord and induce symptoms mimicking ischemic stroke; though common neurological deficits associated with spinal epidural hematoma include paraparesis and quadriparesis, acute hemiparesis, which has been documented, may cause misdiagnosis. The authors present an extremely rare case of spontaneous cervical epidural hematoma exacerbated by TPA administration for hemiparesis and later treated by emergency posterior cervical decompression and fusion
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