急性期脳梗塞を併発した頚髄硬膜外血腫の1例

抄録

  We report a case of a 92-year-old female who presented with a sudden onset of right hemiparesis and neck pain mimicking ischemic stroke without trauma.

  She was initially suspected to have ischemic stroke ; thus, imaging examination of her brain was performed.

  Magnetic resonance imaging (MRI) of the head demonstrated a high diffusion-weighted imaging (DWI) signal in the left occipital lobe. In addition, magnetic resonance angiography (MRA) of the head demonstrated a severe stenosis in the left middle cerebral artery (M1).

  At the emergency room, however, her condition could not be correctly diagnosed.

  One day after admission, MRI of the cervical spine revealed an acute cervical epidural hematoma from the C2 to C5 levels.

  The axial image showed an epidural hematoma that shifted to the left in the spinal canal, compressing the spinal cord and causing hemiparesis and neck pain.

  She underwent surgical evacuation of the epidural hematoma in the emergency room and recovered.

  Recently, spontaneous cervical epidural hematoma has been indicated to mimic ischemic stroke.

  Spontaneous cervical epidural hematoma is generally a rare disease and its diagnosis is often difficult, so patients with a sudden onset of hemiparesis can be misdiagnosed as cerebral infarction even if they have neck pain.

  In this case, the patient was within the time window for acute ischemic stroke treatment, so it would have been possible to administer recombinant tissue plasminogen activator (rt-PA) had she not complained of neck pain.

  We should keep in mind that spontaneous cervical epidural hematoma may present as a stroke mimic, and it is important to evaluate physical and neurological findings in detail.