Spontaneous Cervical Epidural Hematoma Mimicking Acute Ischemic Stroke

Home , Epidural hematoma

Published Ahead of Print on August 4, 2020 as 10.1212/WNL.0000000000010511

Rahangdale 1

Neurology Publish Ahead of Print DOI: 10.1212/WNL.0000000000010511

Spontaneous cervical epidural hematoma mimicking acute ischemic stroke

Rahul Rahangdale, MD1, John Coburn, MD2, Christopher Streib, MD1

1 Department of Neurology, University of Minnesota, Minneapolis MN

2 Division of Neuroradiology, Midwest Radiology PA, St. Paul, MN

Corresponding author: Rahul Rahangdale, Email: [email protected]

Title character count: 70 Abstract word count: 0 Manuscript word count: 100 Legends word count: 50 References: 2 Figures: 2

Neurology® PublishedACCEPTED Ahead of Print articles have been peer reviewed and accepted for publication. This manuscript will be published in its final form after copyediting, page

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Keywords: Spontaneous cervical spinal epidural hematoma, Stroke mimics, IV tPA

Disclosure:

R.Rahangdale. reports no disclosures relevant to the manuscript; J.Coburn. reports no

disclosures relevant to the manuscript; C.Streib. reports no disclosures relevant to the

manuscript.

Study funding:

No targeted funding reported.

Manuscript:

A 67-year-old male presented with acute right hemiparesis and hemianesthesia (NIHSS

5). Hyperacute neuroimaging was interpreted as normal. Following IV tPA, his

symptoms worsened with concern for cervical radiculopathy. Upon reviewing the CT

angiogram (CTA), a possible spinal epidural hematoma (EDH) was noted and

subsequently confirmed with MRI (figure 1). Cryoprecipitate was administered. His

symptoms gradually improved with conservative management. Spontaneous spinal EDH

is rare (incidence: 0.1/100,000 per year).1 Risk factors include hypertension and

1 ACCEPTED2 coagulopathy. Although cervical spine EDH is best visualized with MRI , dedicated

attention to the CTA may reveal this uncommon stroke mimic prior to thrombolysis

(figure 2).

References:

1. Figueroa J, DeVine JG. Spontaneous spinal epidural hematoma: literature review. J

Spine Surg. 2017;3(1):58‐63

2. Pierce JL, Donahue JH, Nacey NC, et al. Spinal Hematomas: What a Radiologist

Needs to Know. Radiographics 2018; 38(5):1516-1535

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Figure legends:

Figure 1: Cervical spine MRI images

(a) Axial and (b) sagittal T2-weighted images demonstrate a hyperintense extramedullary

fluid collection (arrows) consistent with spinal epidural hematoma.

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Figure 2: Head and Neck CT angiogram (CTA) images

(a) Unlabeled and (b) labeled images with standard CTA window width/level settings,

and (c) tailored settings optimizing the density differential between epidural hematoma

(arrows) and laterally displaced spinal cord (SC).

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Appendix 1: Authors

Name Location Contribution

Department of Neurology, Study design; acquisition of data; Rahul Rahangdale, MD University of Minnesota, drafting of the manuscript Minneapolis, Minnesota

Division of Neuroradiology, Interpretation of data; critical John Coburn, MD Midwest Radiology PA, St. revision of the manuscript Paul, Minnesota

Department of Neurology, Christopher Streib, MD, Study concept; critical revision of University of Minnesota, MS the manuscript Minneapolis, Minnesota

ACCEPTED

Copyright © 2020 American Academy of Neurology. Unauthorized reproduction of this article is prohibited Spontaneous cervical epidural hematoma mimicking acute ischemic stroke Rahul Rahangdale, John Coburn and Christopher Streib Neurology published online August 4, 2020 DOI 10.1212/WNL.0000000000010511

This information is current as of August 4, 2020

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