Case of idiopathic cervical spinal subarachnoid hematoma mimicking an epidural hematoma: A case report

Cervical spinal subarachnoid hematoma (SSAH) is rare and may mimic epidural or subdural hematoma on magnetic resonance imaging (MRI). This makes it difficult to correctly localize the hematoma on the preoperative magnetic resonance, thus typically warranting surgery.

A 78-year-old female presented with the sudden onset of neck pain and progressive left hemiparesis. The cervical MRI showed a left dorsolateral C3-C5 compressive hematoma, thought initially to represent an epidural clot. The accompanying computed tomography angiogram (i.e., without preoperative digital subtraction angiography) showed no vascular abnormality. Due to rapid neurological deterioration, the patient underwent an emergency decompression. At surgery, no epidural hematoma was found; rather, following a durotomy, arachnoid dissection revealed an organized SSAH without abnormal vessels that were removed en bloc. The patient improved immediately after surgery, and the postoperative MRI confirmed adequate decompression.

Idiopathic cervical SSAH should be included in the differential diagnosis of acute cervical compressive hematomas. As MRI may not reliably define the location of the hematoma, those demonstrating progressive neurological deterioration typically warrant surgery, even without a full vascular work-up.