Abstract Details

Title Spontaneous Spinal Epidural Hematoma Presented with Acute Hemiparesis: A Stroke Mimicker

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P11 - Poster Session 11 (5:30 PM-6:30 PM)

Poster/Presentation
Number 5-015

Objective To describe a case of spontaneous spinal epidural hematoma (SSEH) mimicking acute ischemic stroke (AIS) and its outcome post intravenous thrombolysis.

Background SSEH is an exceedingly rare condition with a prevalence of 1:1000000. It may manifest with hemiparesis mimicking AIS. The diagnosis of SSEH is often made after clinically worsening due to IV thrombolysis.

Design/Methods N/A

Results 81-year-old male with history of hypertension, hyperlipidemia, type 2 diabetes mellitus presented with sudden onset left arm and leg weakness upon awakening 6 hours after his last known well. NIHSS was 4 (left face, arm, leg paresis and left hypoesthesia). He received intravenous thrombolysis as the 24-hour late presenter thrombolysis protocol of our institution and clinically his left hemiparesis improved. He was admitted to the neurosciences intensive care unit and 3 hours later was symptomatically improved but complaining of neck pain. 8 hours later, the patient developed acute weakness of the right side contralateral to initial stroke symptoms. Emergent MRI brain showed no acute infarct but the MRI cervical spine revealed a heterogenous T2 hyperintense extramedullary lesion, extending from C4 through the thoracic spine mostly consistent with epidural hemorrhage, with significant mass effect on the spinal cord, resulting in severe spinal canal narrowing. Patient underwent emergent surgical spinal decompression after reversal of IV tPA with cryoprecipitate and intraoperative tranexamic acid during the evacuation of the epidural hematoma. Clinically he improved postoperatively and was discharged to rehab. Only 12 stroke mimic cases of SSEH have been reported in which IV tPA was administered.

Conclusions Diagnosis of SSEH is challenging as it can present with hemiparesis, mimicking AIS. Neck pain should raise suspicion of SSEH. Careful imaging evaluation of the cord including standard-of-care CTA neck angiography may lead to a faster diagnosis.

Authors/Disclosures
Camelia Valhuerdi Porto, MD (Tufts Medical Center) PRESENTER	Dr. Valhuerdi Porto has nothing to disclose.
Rafail A. Chionatos, MD (Tufts Medical Center)	Dr. Chionatos has nothing to disclose.
Amr Jijakli, MBBS, MPH (Tufts Medical Center)	Dr. Jijakli has nothing to disclose.
Emiliya Melkumova, MD (Tufts University Medical Center)	Dr. Melkumova has nothing to disclose.
Xuemei Cai, MD, FAAN (Tufts Medical Center)	Dr. Cai has received personal compensation for serving as an employee of Pfizer. Dr. Cai has stock in Pfizer.

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