Abstract
We describe a 52 year-old woman with spontaneously resolving spinal epidural hematoma presenting with neck pain and hemiparesis, which allows us to evaluate sequential changes of hematoma on MRI. The patient complained of sudden onset of left-sided neck pain and left hemiparesis, and was admitted to our hospital. Although initial MRI of the brain showed no abnormalities, subsequent cervical MRI revealed a fusiform mass lesion extending from C2 to C5 with compression of the spinal cord, suggesting the presence of spinal epidural hematoma. Since the neurological status improved gradually, we selected conservative therapy including strict bed rest, serial neurological examination and pain control. Repeat MRI showed gradual regression of hematoma, which was well correlated with clinical improvement. T1 and T2 signals associated with hematoma varied based on clot characteristics and oxygenation. The patient was discharged without any neurological deficits 22 days after onset. Follow-up MRI 2 weeks after discharge revealed complete disappearance of hematoma. Previously, immediate surgical evacuation of hematoma was suggested, but in selected patients with early and progressive neurological recovery, conservative management monitored by serial MRIs may be possible. Spinal epidural hematoma with hemiparesis is rare and can be misdiagnosed as cerebral infarction. We emphasize that cervical lesions should be considered in the differential diagnosis of hemiparesis with neck pain as well.
