Inatomi Yuichiro, Nakajima Makoto, Yonehara Toshiro
Department of Neurology, Saiseikai Kumamoto Hospital, Chikami 5-3-1, Minami-ku, Kumamoto 861-4193, Japan.
Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Japan.
J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105030. doi: 10.1016/j.jstrokecerebrovasdis.2020.105030. Epub 2020 Jun 23.
Spinal epidural hematoma is a rare but important disease as it can be a stroke mimic. Our aim was to investigate the clinical characteristics of patients with an activated stroke code and spinal epidural hematoma.
Patients with an activated stroke code were examined retrospectively. Patients with spinal epidural hematoma were evaluated with further neurological examinations and neuroimaging.
Of 2866 patients with an activated stroke code, spinal epidural hematoma was detected in 5 (0.2%, 63-79 years, 2 men). In all 5 cases, hematoma was located in the unilateral dorsal region of the spinal canal and spread to 5-9 vertebral segments at the C1-T3 level. None of the patients had a medical history of head or neck injury, coagulopathy, or use of anti-thrombotic agents. All of the patients had occipital, neck, and/or back pain, and their hemiparesis occurred simultaneously or within 1 h after the onset of pain. Hyperalgesia ipsilateral to the hematoma was observed in 1 patient, hypoalgesia contralateral to the hematoma was observed in 1, and quadriparesis and bilateral hypoalgesia were observed in 1. The hematomas spontaneously decreased in size in 4 patients, and cervical laminectomy was performed in the other patient. In the 1860 patients with an activated stroke code and spontaneous eye opening, the sensitivity of pain as a predictor of spinal epidural hematoma was 100%, with a specificity of 88.7%, and positive predictive value of 2.3%.
Patients with spinal epidural hematoma could present with clinical characteristics mimicking ischemic stroke. Spinal epidural hematoma should be differentiated in patients treated under stroke code activation.
脊髓硬膜外血肿是一种罕见但重要的疾病，因为它可能类似中风。我们的目的是研究启动中风代码且患有脊髓硬膜外血肿患者的临床特征。
对启动中风代码的患者进行回顾性检查。对患有脊髓硬膜外血肿的患者进行进一步的神经学检查和神经影像学评估。
在2866例启动中风代码的患者中，检测到5例脊髓硬膜外血肿（0.2%，年龄63 - 79岁，2例男性）。所有5例患者的血肿均位于椎管的单侧背侧区域，在C1 - T3水平累及5 - 9个椎体节段。所有患者均无头部或颈部损伤、凝血功能障碍或使用抗血栓药物的病史。所有患者均有枕部、颈部和/或背部疼痛，且偏瘫在疼痛发作同时或发作后1小时内出现。1例患者出现血肿同侧痛觉过敏，1例出现血肿对侧痛觉减退，1例出现四肢瘫和双侧痛觉减退。4例患者的血肿大小自发减小，另1例患者接受了颈椎椎板切除术。在1860例启动中风代码且能自主睁眼的患者中，疼痛作为脊髓硬膜外血肿预测指标的敏感性为100%，特异性为88.7%，阳性预测值为2.3%。
脊髓硬膜外血肿患者可能表现出类似缺血性中风的临床特征。在启动中风代码治疗的患者中应鉴别出脊髓硬膜外血肿。
