• Tadatsugu Morimoto, Tomohito Yoshihara, Yusuke Yakushiji, Makoto Eriguchi, Hideo Hara, Motoki Sonohata, and Masaaki Mawatari.
• *Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Nabeshima, Saga, Japan †Department of Neurology, Faculty of Medicine, Saga University, Nabeshima, Saga, Japan.
• Spine. 2016 Apr 1; 41 (7): E437-40.

Study DesignCase report.ObjectiveTo report an extremely rare case of stroke-mimicking, cervical spontaneous epidural hematoma (SEH) treated with tissue plasminogen activator (tPA) for hemiparesis followed by emergency cervical decompression.Summary Of Background DataAlthough hemiparesis caused by cervical SEH is a relatively uncommon symptom compared with tetraparesis, such cases were often misdiagnosed as cerebral infarction and worsened by antithrombic therapy.MethodsA case report and literature review are presented.ResultsA 71-year-old male presented with sudden neck pain followed by left-sided hemiparesis, and was believed to have had a stroke. He was administered tPA as intracranial computed tomography showed no signs of hemorrhage. However, his neurological condition continued to decline, and MRI of the cervical spine revealed a large spontaneous epidural hematoma. He subsequently underwent evacuation of the epidural hematoma and C3-6 laminoplasty, and his clinical status improved after the surgery.ConclusionTo our knowledge, only three cases of cervical SEH with hemiparesis erroneously treated with tPA resulting in neurological decline because of the enlargement of an existing hematoma, including the current case, have been reported in the English literature. It is important for physicians, especially those who administer tPA treatment, to include cervical SEH in the differential diagnosis of stroke in patients presenting with sudden back pain followed by the onset of neurological deficits including hemiparesis.Level Of Evidence5.

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