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Spontaneous Cervical Epidural Hematoma Mimicking Acute Ischemic Stroke 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 composition, and review of proofs. Errors that could affect the content may be corrected during these processes. Copyright © 2020 American Academy of Neurology. Unauthorized reproduction of this article is prohibited Rahangdale 2 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). Copyright © 2020 American Academy of Neurology. Unauthorized reproduction of this article is prohibited Rahangdale 3 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 ACCEPTED Copyright © 2020 American Academy of Neurology. Unauthorized reproduction of this article is prohibited Rahangdale 4 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. ACCEPTED Copyright © 2020 American Academy of Neurology. Unauthorized reproduction of this article is prohibited Rahangdale 5 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). ACCEPTED Copyright © 2020 American Academy of Neurology. Unauthorized reproduction of this article is prohibited Rahangdale 6 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 Updated Information & including high resolution figures, can be found at: Services http://n.neurology.org/content/early/2020/08/04/WNL.0000000000010 511.citation.full Subspecialty Collections This article, along with others on similar topics, appears in the following collection(s): All Cerebrovascular disease/Stroke http://n.neurology.org/cgi/collection/all_cerebrovascular_disease_strok e Permissions & Licensing Information about reproducing this article in parts (figures,tables) or in its entirety can be found online at: http://www.neurology.org/about/about_the_journal#permissions Reprints Information about ordering reprints can be found online: http://n.neurology.org/subscribers/advertise Neurology ® is the official journal of the American Academy of Neurology. Published continuously since 1951, it is now a weekly with 48 issues per year. Copyright © 2020 American Academy of Neurology. All rights reserved. Print ISSN: 0028-3878. Online ISSN: 1526-632X..
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