Le Coz P, Helias A, Woimant F, Haguenau M
Service de Neurologie, Hôpital Lariboisière, Paris.
Rev Neurol (Paris). 1997 Jun;153(5):325-30.
Spontaneous cervical epidural hematomas are uncommon lesions that usually produce permanent neurological deficit unless there is early surgical decompression. They are now well-recognized by scan X and especially by sagittal MRI of the spine. We describe 2 patients, a 24 year-old man and a 79 year-old woman with no previous history of trauma who were admitted in emergency for a sudden weakness of limbs, respectively a tetraplegia and a right hemiplegia. Both patients complained of inaugural and acute neck pain. Motor deficit completely resolved in few hours and MRI of the spine showed on T1 a signal isointense, extending respectively from C3 to C6 and C5 to C7, consistent with an hematoma. Laboratory data and angiography were normal. Surgery was recused. Neck pain lasted about a week. Follow-up MRI, in one case, was normal two months later. Cervical epidural hematomas revealed by transient neurological findings that completely and permanently resolved are exceptional. They could mimic ischemic myelopathy and should be considered in the differential diagnosis of other painful vascular conditions like symptomatic vertebral dissection to avoid inappropriate anticoagulation. Conservative management in these cases may be proposed if spontaneous neurological resolution is confirmed by MRI.
自发性颈段硬膜外血肿是一种罕见的病变，通常会导致永久性神经功能缺损，除非早期进行手术减压。现在通过X线扫描，尤其是脊柱矢状位磁共振成像（MRI），它们已得到很好的识别。我们描述了2例患者，一名24岁男性和一名79岁女性，既往均无创伤史，分别因突发肢体无力（四肢瘫和右侧偏瘫）而急诊入院。两名患者均主诉首发及急性颈部疼痛。运动功能缺损在数小时内完全恢复，脊柱MRI在T1加权像上显示等信号，分别从C3延伸至C6和从C5延伸至C7，符合血肿表现。实验室检查数据和血管造影均正常。未进行手术。颈部疼痛持续约一周。在其中1例患者中，两个月后的随访MRI检查结果正常。由短暂性神经学表现揭示且完全永久性恢复的颈段硬膜外血肿非常罕见。它们可能会模仿缺血性脊髓病，在鉴别诊断其他疼痛性血管疾病（如症状性椎动脉夹层）时应予以考虑，以避免不适当的抗凝治疗。如果MRI证实神经功能自发恢复，这些病例可建议采取保守治疗。
