[Chronic cervical epidural hematoma diagnosed by magnetic resonance imaging]

The clinical picture of spinal epidural hematoma is usually characterized by the sudden onset of pain and acute paraplegia within a few hours. The reports of chronic spinal epidural hematoma above the lumbar level is extremely rare. Here we added one case whose hematoma was at cervical level. A 31-year-old previously healthy male suffered from continuous sharp pain in the back of his neck about 10 weeks before admission. He took analgesic drugs and treated with head traction by his home doctor with minimal relief. 4 weeks later from onset progressive weakness and numbness appeared at his right hand and arm. Physical examination on admission revealed mild monoparesis and sensory disturbance in his right upper limb. There was hyporeflexia of both upper extremities. Magnetic resonance imaging (MRI; Hitachi 0.2 T) visualized a dorsal epidural space occupying lesion extending from C3 to Th1 vertebral body level. This revealed high signal intensity in T2 weighted image and mixed (low and iso) signal intensity in T1 weighted image corresponding to old hematoma. All his medication was stopped and he treated with collar brace, which improved his neurological status. 3 weeks later, he recovered fully and follow-up MRI revealed the total absorption of the hematoma. Left vertebral angiogram showed that a part of posterior cerebral venous blood drained to cervical vertebral plexus. This finding suggested his epidural bleeding was venous in origin. Rupture of internal vertebral venous plexus that has no valves was considered as the source of spinal epidural hematoma.(ABSTRACT TRUNCATED AT 250 WORDS)