Szeto Cheuk Ling Charing, Hui Kwok Fai
Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong, China.
Cerebrovasc Dis. 2022;51(2):265-269. doi: 10.1159/000518525. Epub 2021 Sep 15.
Spontaneous spinal epidural hematoma (SSEH) is a rare neurological emergency. Its presentation, depending on location of hematoma, could mimic stroke. While intravenous thrombolysis (IVT) is recommended to commence as early as possible in case of acute ischemic stroke, it is likely that it could be given to SSEH patients. We aimed to examine the prevalence, outcome, and prognosis of such patients.
We have retrospectively screened all patients given IVT from January 2008 to March 2021 admitted to United Christian Hospital, a tertiary hospital in Hong Kong. We reviewed the final diagnosis of all patients and included cases diagnosed with SSEH. Their clinical and radiological features, treatment, and outcome were analyzed. We further performed a literature review to search for all cases with SSEH given IVT and review their clinical features and outcome.
Out of a total of 940 patients over the 12-year span, 2 patients were diagnosed with SSEH, accounting for 0.21% of cases. From our literature search, to date, there are only 10 cases that had been reported from 5 case reports where IVT was given to SSEH patients. Of the 12 cases, all presented with hemiparesis and 9 with pain. Of those with neck pain, 3 with initial computed tomography angiogram done showed SSEH which was missed initially. Eight were treated surgically and 4 conservatively. All recovered with no major disability.
Though a rare disease, awareness toward SSEH presenting as stroke mimic should be raised.
自发性脊髓硬膜外血肿（SSEH）是一种罕见的神经系统急症。其临床表现取决于血肿的位置，可能类似中风。虽然急性缺血性中风建议尽早开始静脉溶栓（IVT），但SSEH患者也可能接受该治疗。我们旨在研究此类患者的患病率、结局和预后。
我们回顾性筛查了2008年1月至2021年3月期间入住香港三级医院联合医院接受IVT治疗的所有患者。我们复查了所有患者的最终诊断，纳入了诊断为SSEH的病例。分析了他们的临床和影像学特征、治疗及结局。我们还进行了文献综述，以查找所有接受IVT治疗的SSEH病例，并回顾其临床特征和结局。
在这12年期间的940例患者中，2例被诊断为SSEH，占病例总数的0.21%。通过文献检索，迄今为止，仅有5篇病例报告共报道了10例接受IVT治疗的SSEH患者。在这12例患者中，均出现偏瘫，9例伴有疼痛。在颈部疼痛患者中，3例最初进行计算机断层血管造影显示为SSEH，但最初被漏诊。8例接受手术治疗，4例保守治疗。所有患者均康复，无严重残疾。
虽然SSEH是一种罕见疾病，但应提高对表现类似中风的SSEH的认识。
