Kameda Tomoaki, Doi Hiroshi, Sugiyama Mikiko, Ueda Naohisa, Kugimoto Chiharu, Baba Yasuhisa, Murata Hidetoshi, Suzuki Yume, Kuroiwa Yoshiyuki
Department of Clinical Neurology and Stroke Medicine, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
Brain Nerve. 2009 Dec;61(12):1429-33.
We report 3 cases of spontaneous cervical epidural hematoma with sudden onset of neck pain followed by the development of unilateral limb weakness. All of the patients were initially suspected to have acute ischemic stroke. We considered using intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) to treat 2 of the 3 patients who had arrived at our hospital within 2 hours of the symptom onset. However, we did not administer rt-PA therapy to these patients because the symptoms were mild. We treated all 3 patients with other antithrombotic drugs until the diagnosis of cervical epidural hematoma was confirmed. Patients with spontaneous cervical epidural hematoma usually present with acute neck pain followed by the development of bilateral limb weakness and urine retention; unilateral limb weakness is rare. Patients with this uncommon presentation must be distinguished from stroke.
我们报告3例自发性颈段硬膜外血肿,患者均突然出现颈部疼痛,随后出现单侧肢体无力。所有患者最初均被怀疑患有急性缺血性卒中。对于3例中2例在症状发作后2小时内抵达我院的患者,我们曾考虑使用重组组织型纤溶酶原激活剂(rt-PA)进行静脉溶栓治疗。然而,由于症状较轻,我们未对这些患者进行rt-PA治疗。在颈段硬膜外血肿确诊之前,我们用其他抗血栓药物对所有3例患者进行了治疗。自发性颈段硬膜外血肿患者通常先出现急性颈部疼痛,随后出现双侧肢体无力和尿潴留;单侧肢体无力较为罕见。必须将具有这种不常见表现的患者与卒中相鉴别。