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Acute hemiparesis

A rare presentation of spontaneous spinal epidural hematoma mimicking acute stroke

Da-Wei Huang, Jui-Ming Sun, Yu-Hao Chen and Kuo-Chang Huang
Neurosciences Journal August 2020, 25 (4) 316-319; DOI: https://doi.org/10.17712/nsj.2020.4.20200027

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    Magnetic resonance images of the cervical spine showing A) Axial T2-weighted image shows a mass (white arrow) in the right dorsal portion of the cervical canal above the C3 level, compressing the spinal cord. B) Sagittal T1-weighted image shows mass isointensity (white arrow). C) Sagittal T2-weighted image shows high mass intensity (white arrow).

  • Figure 2
    Figure 2

    Intraoperative view following laminectomy; hematoma (white arrow) mainly located on the right dorsal aspect of the C3 region.

Tables

  • TABLE 1

    The timeline for the presented case.

    DatesRelevant past medical history and interventions
    She denied a history of hypertension, taking anticoagulant/antiplatelet medication, or trauma events.
    Summaries from initial and follow-up visitsDiagnostic testing (including dates)Interventions
    2020/1/3

    • Sudden-onset neck pain, right facial numbness, and right-sided weakness

    • Visiting our ER 2 hours later after the onset of symptoms

    • Hemoglobin level of 10.8 mg/dL and platelet count of 263,000/μL. (2020/1/3)

    • A coagulation test produced normal results. (2020/1/3)

    • A computed tomography (CT) scan of the brain revealed no intracranial hemorrhage. CT angiography revealed no evidence of major vessel occlusion or artery dissection. (2020/1/3)

    • Intravenous recombinant tissue plasminogen activator (rtPA) was administrated within 4.5 hours of symptom onset. (2020/1/3)

    2020/1/3Left-side weakness developed 3 hours later rtPA injection

    • Subsequent magnetic resonance images of the brain and cervical spine revealed a mass in the right dorsal portion of the cervical canal above the C3 level that was compressing the spinal cord (2020/1/3)

    • Emergent laminectomy with hematoma removal 12 hours after symptom onset. (2020/1/3)

    2020/1/8The motor strength of the left extremities recovered to grade 4
    2020/1/21Discharge with right extremities recovered to grade 3
    2020/2/5She could walk with walker
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