Lim Shawn Wen-Yang, Wong Evelyn
Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.
Am J Case Rep. 2020 Oct 8;21:e926784. doi: 10.12659/AJCR.926784.
BACKGROUND This report presents the case of a woman with no known coagulopathy, use of anticoagulants, or history of trauma who spontaneously developed an epidural hematoma of the spine. This is an uncommon condition, with the potential for missed diagnosis and potential harm to the patient. CASE REPORT The patient was an elderly woman with a history of Type 2 diabetes mellitus and hyperlipidemia. Of note, she had recently recovered from COVID-19. Because the woman presented with right-sided weakness and pain in the back of her neck, the stroke team was activated. A computed tomography (CT) scan of her neck revealed a very subtle hyperdensity, which on further investigation was found to be an acute epidural hematoma at C2-C3 space through the C6 vertebra. While awaiting surgery, the patient had spontaneous improvement of her right-sided weakness and her condition eventually was managed conservatively. CONCLUSIONS Spontaneous spinal epidural hematoma is an uncommon condition, and a high index of suspicion is required to accurately diagnose and appropriately manage it. In the case presented here, the hematoma was subtle on the CT scan, and the patient's weakness easily could have been misdiagnosed as an ischemic stroke. That may have resulted in administration of thrombolytics, potentially causing significant harm. In addition, the patient had recently recovered from COVID-19 disease, which may or may not be incidental. Further observation will be required to determine if there is a spike in similar cases, which may be temporally associated with the novel coronavirus.
背景 本报告介绍了一名无已知凝血功能障碍、未使用抗凝剂且无创伤史的女性自发发生脊柱硬膜外血肿的病例。这是一种罕见的病症，有可能漏诊并对患者造成潜在伤害。病例报告 患者为一名老年女性，有2型糖尿病和高脂血症病史。值得注意的是，她最近从新冠病毒感染中康复。由于该女性出现右侧肢体无力和颈部后方疼痛，卒中团队被启动。对其颈部进行的计算机断层扫描（CT）显示有一个非常细微的高密度影，进一步检查发现是C2 - C3至C6椎体间隙的急性硬膜外血肿。在等待手术期间，患者右侧肢体无力自发改善，最终其病情采用保守治疗。结论 自发性脊柱硬膜外血肿是一种罕见病症，需要高度怀疑指数才能准确诊断并妥善处理。在本病例中，CT扫描上血肿很细微，患者的无力症状很容易被误诊为缺血性卒中。这可能导致使用溶栓药物，从而可能造成重大伤害。此外，患者最近从新冠病毒感染中康复，这可能是偶然情况，也可能并非偶然。需要进一步观察以确定类似病例是否会激增，这可能与新型冠状病毒在时间上有关联。
