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A rare case of spontaneous cervical epidural haematoma mimicking a stroke
EP37536
Poster Title: A rare case of spontaneous cervical epidural haematoma mimicking a stroke
Submitted on 13 Aug 2021
Author(s): Fionn Donnelly, Glen Clarke, Breffni Keegan
Affiliations: South West Acute Hospital
This poster was presented at European Congress of Internal Medicine
Poster Views: 310
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Poster Information
Abstract: Case Description

A 78 year-old woman presented following development of sudden onset occipital headache alongside left arm and leg weakness whilst dressing. The headache radiated to her neck and shoulders. Her medical history included hypertension, hypercholesterolemia, previous episode of right sided amaurosis fugax and an ex-smoker status.

Initial examination demonstrated marked left arm and leg weakness, in absence of sensory or cranial nerve deficit.

Methods

Initial hypothesis was of an acute stroke or subarachnoid haemorrhage. CT brain failed to demonstrate intracranial haemorrhage, with CT angiography excluding dissection as a factor and MRI brain showing no evidence of an acute infarct.

Diagnostic Pathways

Owing to severity of neck pain, MRI of cervical spine was requested in advance of considering thrombolysis. This revealed an epidural haematoma of cervical spinal canal with cord displacement and compression.

The patient was referred to for urgent neurosurgical intervention. She underwent a spinal decompression and rapidly regained power post-surgery, alongside allied health rehabilitation.

Conclusions

Symptoms of cervical epidural haematoma symptoms may present suddenly, similar to a stroke, though neurological impairment is due to haematoma compression of spinal cord rather than supratentorial infarct or bleed. A high index of suspicion is required, and MRI of cervical spine indicated where doubt exists, prior to administration of thrombolysis or antiplatelet therapy.
Summary: This case highlights the importance of careful history taking in the management of a patient with common stroke symptoms, and the need for caution where atypical symptoms, such as severe neck pain in this instance present.References:
1: Fukui MB, Swarnkar AS, Williams RL. Acute spontaneous spinal epidural hematomas. AJNR Am J Neuroradiol. 1999 Aug;20(7):1365-72. PMID: 10472999; PMCID: PMC7055980.
2: Sklar EM, Post JM, Falcone S. MRI of acute spinal epidural hematomas. J Comput Assist Tomogr. 1999 Mar-Apr;23(2):238-43. doi: 10.1097/00004728-199903000-00012. PMID: 10096331.
3: Counselman FL, Tondt JM, Lustig H. A Case Report: The Challenging Diagnosis of Spontaneous Cervical Epidural Hematoma. Clin Pract Cases Emerg Med. 2020 Aug;4(3):428-431. doi: 10.5811/cpcem.2020.5.47107. PMID: 32926704; PMCID: PMC7434283
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