A case of spontaneous spinal epidural hematoma that mimicked acute cerebral ischemic stroke and was treated by a recombinant tissue-type plasminogen activator

Summary: A healthy 49-year-old female complaining of progressive hemiplegia of the left side consulted the Emergency Department. Neurological examinations and non-contrast computed tomography of the brain showed no evidence of hemorrhage. Acute ischemic stroke was diagnosed, and intravenous recombinant tissue-type plasminogen activator was administered under the guidelines of the National Institute of Neurological Disorders. After starting the treatment, the patient developed progressive quadriplegia and pain in the back of her neck. Cervical magnetic resonance imaging showed a vast epidural hematoma. The patient underwent emergency decompression surgery and removal of the hematoma by spine surgeons. Intraoperative epidural bleeding was observed on the left side at the C3-C4 level. Postoperatively, the patient showed significant improvement, becoming neurologically intact and functional by the 14-month follow-up. Importantly, this case illustrates that a cervical epidural hematoma can present as hemiplegia, which can be misdiagnosed as a cerebrovascular accident in neurology emergency rooms.