[A case of spontaneous spinal epidural hematoma presenting Brown-Séquard syndrome]

Although there have been a few reports of spontaneous spinal epidural hematoma, it may be difficult to make a correct diagnosis of the lesion because of atypical clinical symptoms. The authors reported a case of spontaneous spinal epidural hematoma presenting Brown-Séquard syndrome, with a review of literature. This 75-year-old male experienced a sudden onset of severe dorsal neck pain during sleep associated with right hemiparesis which deteriorated quickly to hemiplegia, without loss of consciousness, nausea, vomiting and vertigo. The patient has a history of hypertension and has been treated for chronic hepatitis for one year. On admission, neurological examination revealed right hemiplegia with normotensive deep tendon reflexes, and loss of pain and temperature sensations below the level of C5 on his left side. Position sense of fingers and toes was diminished on his right side, and hyperesthesia was recognized at the area of C4 level. Consciousness disturbance, cranial nerve signs, and urinary incontinence were not seen. Right retrograde vertebral angiograms showed no abnormal vascular shadow, even though anterior spinal artery was visible at the level of C8 through C5. Cervical CT scan revealed a left-side dominant extradural high density mass which situated dorsally at around the upper part of C2 body changing it's position to dorsolaterally as it descended to the lower part of C5. On contrast enhancement study, only the margin of the lesion was partially enhanced, which might be the hematoma membrane. On the third day after the onset, laminectomy from C2 to C5 was performed and the epidural hematoma was evacuated.(ABSTRACT TRUNCATED AT 250 WORDS)