Kato Daisuke, Terae Satoshi
Department of Diagnostic Radiology, Sapporo City General Hospital.
No Shinkei Geka. 2021 Mar;49(2):356-361. doi: 10.11477/mf.1436204398.
A woman in her 60s was admitted to our hospital because of sudden-onset right hemiparesis, paresthesia, and neck pain. At first, a head CT scan was performed to rule out stroke, which did not detect any abnormalities. Subsequently, a neck CT scan was performed, which revealed a mild high-density structure compressing the dural sac within the cervical spinal canal. She was suspected to have a spinal hematoma. A MRI scan revealed a spindle-shaped structure with a heterogeneous high signal on T2-weighted and a mild high signal on T1-weighted sagittal images, which led to the diagnosis of a spontaneous spinal epidural hematoma. The patient was treated with conservative therapy upon which her symptoms improved. She was discharged seven days after admission. Spontaneous cervical spinal epidural hematoma often causes neck pain followed by unilateral spinal cord compression symptoms(such as hemiparesis and paresthesia)and can be misdiagnosed as a stroke. In cases of hemiparesis with sudden-onset neck pain, cervical lesions should be considered in the differential diagnoses in addition to stroke.
一位60多岁的女性因突发右侧偏瘫、感觉异常和颈部疼痛入院。起初，进行了头部CT扫描以排除中风，未发现任何异常。随后进行了颈部CT扫描，显示颈椎管内有一个轻度高密度结构压迫硬脊膜囊。怀疑她患有脊髓血肿。MRI扫描显示在T2加权矢状位图像上有一个梭形结构，信号不均匀且呈高信号，在T1加权图像上呈轻度高信号，从而诊断为自发性脊髓硬膜外血肿。患者接受了保守治疗，症状有所改善。入院七天后出院。自发性颈椎硬膜外血肿常导致颈部疼痛，随后出现单侧脊髓压迫症状（如偏瘫和感觉异常），可能被误诊为中风。对于突发颈部疼痛伴偏瘫的病例，除中风外，鉴别诊断时还应考虑颈椎病变。
