Article ID: 10979
Spinal epidural hematoma may have symptoms similar to those of a stroke sometimes. Hence, it is important to perform an accurate diagnosis through exclusion before the thrombolytic therapy with rt-PA is started. In this study, we report a case of severe epidural hematoma, which was misdiagnosed as acute ischemic stroke and treated with rt-PA. A 67-year-old woman was transferred to our hospital with impaired consciousness and respiratory failure following back and neck pain. Brain CT and CT angiography did not show cerebral hemorrhage and large vessel occlusion. Although her consciousness and respiratory state were improved after radiological examination, severe right hemiparesis remained. The patient was diagnosed with acute ischemic stroke, and we started thrombolytic therapy with rt-PA. Furthermore, respiratory failure and tetraplegia were reported, and a consequent emergent reexamination CT revealed cervical spinal epidural hematoma. Thus, we performed a multivertebral hemilaminectomy and epidural hematoma removal seven hours after rt-PA administration. Her symptoms gradually improved, and she recovered with only a minor skillful movement disorder three months later. The thrombolytic therapy with rt-PA is well established and effective for acute ischemic strokes and is recommended to be initiated as quickly as possible. Although spinal epidural hematoma is a rare disease, it may mimic a stroke and has symptoms different from the usual, as reported in this case, which are neck pain at onset and fluctuating neurological symptom. Thus, accurate diagnosis should be prioritized before starting the rt-PA therapy.
