Spontaneous Cervical Epidural Hematoma. A Case Report

Spontaneous spinal epidural hematoma is a rare disorder. We present a case of a 55-year-old man who was awakened by severe pain in the neck and shoulders and inability to move his arms and legs. He was admitted to the clinic as an emergency. His physical status showed no abnormalities. The local status presented with roughly expressed cervical vertebral syndrome. Neurological examination found quadriplegia of acute onset. Distal parahypesthesia with sensory level at the nipples was found. The patient suffered urine retention. Laboratory blood tests showed no coagulation disorder. Spiral computed tomography of the cervical region was performed. The CT image revealed a muff-shaped acute epidural hematoma around the cervical dural membrane with lower thickness on the right side and levels from C2 to C4. Emergency right-sided hemilaminectomy of C3 vertebra was performed. A hard blood clot forming acute epidural hematoma was removed. The patient recovered completely for ten days after the surgery. Conclusions: In sudden occurrence of neck pain associated with neurological deficit in the arms spontaneous cervical epidural hematoma should be suspected. Spiral scanner and magnetic resonance are imaging techniques of choice in these patients. The favorable outcome of the disease depends on the prompt diagnosis and emergency removal of the hematoma.