Painless Spontaneous Spinal Epidural Hematoma Mimicking Acute Ischemic Stroke: A Case Report.
Wenji Zhang, Jun Su, Kewu Wang et al.
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Case in brief
A woman in her early 60s receiving anticoagulant and antiplatelet therapy developed neck tightness and numbness in both limbs without pain, followed by transient right hemiplegia and rapid neurological deterioration. MRI showed a C4–T2 cervical epidural hematoma with severe spinal cord compression. She underwent emergency C4–C6 laminectomy, partial C7 laminectomy, and hematoma evacuation. Strength recovered only partially; the authors considered that extensive, prolonged cord compression may have contributed to her poor prognosis.
What made this case unusual
The hematoma presented without typical spinal pain and mimicked acute ischemic stroke, including transient right hemiplegia, in a patient receiving antithrombotic therapies.
Diagnostic / clinical pearl
In patients receiving anticoagulant or antiplatelet therapy, acute bilateral limb symptoms or stroke-like deficits without spinal pain should prompt consideration of spontaneous spinal epidural hematoma.