Nader Fadi, Bassil Georges F, Ali Sleiman Mohamad, Nicolas Nicolas
Orthopedics and Trauma, Université Paris Cité, Paris, FRA.
Orthopedics and Traumatology, Lebanese University Faculty of Medicine, Beirut, LBN.
Cureus. 2023 Aug 8;15(8):e43115. doi: 10.7759/cureus.43115. eCollection 2023 Aug.
Accurate differentiation between epidural hematomas and lumbar disc extrusion is essential due to the potential overlap in clinical presentations. We present a case report highlighting a significant challenge in which a massive lumbar disc extrusion was mistaken for an epidural hematoma. This is a case report of a 38-year-old male patient who developed cauda equina syndrome four days after experiencing an audible cracking in the lower back during weightlifting activity. Magnetic resonance imaging (MRI) was inconclusive, unable to distinguish between an extruded nucleus pulposus and a spinal epidural hematoma. Subsequently, an urgent operation revealed a large herniated disc at the L4-L5 level, ruling out any hematoma. The patient's post-operative follow-up showed significant improvement, with almost complete recovery of motor and sensory functions. This case emphasizes the challenges faced when distinguishing between epidural hematomas and lumbar disc herniations, particularly on MRI. The lumbar disc herniation's substantial size, cranial and caudal migration on multiple levels, and signal intensity contributed to the misdiagnosis, underscoring the importance of careful interpretation and awareness of such complexities.
由于临床表现可能存在重叠，准确区分硬膜外血肿和腰椎间盘突出至关重要。我们报告一例病例，突出显示了一个重大挑战，即巨大的腰椎间盘突出被误诊为硬膜外血肿。这是一例38岁男性患者的病例报告，该患者在举重活动中腰部听到咔嚓声四天后出现马尾综合征。磁共振成像（MRI）结果不明确，无法区分突出的髓核和脊髓硬膜外血肿。随后的紧急手术显示L4-L5水平有一个大的椎间盘突出，排除了任何血肿。患者术后随访显示有显著改善，运动和感觉功能几乎完全恢复。该病例强调了在区分硬膜外血肿和腰椎间盘突出时所面临的挑战，尤其是在MRI上。腰椎间盘突出的巨大尺寸、多节段的上下移位以及信号强度导致了误诊，凸显了仔细解读和认识此类复杂性的重要性。
