Cervical spinal epidural haematoma: the double jeopardy

Area of Science:

• Neurology
• Neurosurgery
• Radiology

Background:

• Spontaneous spinal epidural hematoma (SSEH) is a rare cause of spinal cord compression.
• Radicular pain is an early symptom, often mimicking other conditions like cervical spondylosis or disc herniation.

Observation:

• Cervical epidural hematoma can present with radicular pain mistaken for cardiac pain, especially in patients with existing heart conditions.
• Anticoagulant therapy, such as heparin, can exacerbate SSEH, leading to severe neurological deficits.

Findings:

• SSEH can cause compressive myelopathy or cauda equina syndrome.
• Neck and upper extremity pain with bilateral myelopathy signs suggest acute cervical cord compression.
• Misdiagnosis and inappropriate heparin administration can have catastrophic outcomes.

Implications:

• Early recognition of SSEH is crucial to prevent irreversible neurological damage.
• Distinguishing SSEH from cardiac ischemia is vital for appropriate management.
• Careful consideration of SSEH is necessary in patients with unexplained radicular pain and risk factors for bleeding.