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.