Spontaneous cervical epidural hematomas with acute hemiparesis should be considered a contraindication for intravenous thrombolysis: A case report with a literature review of 50 cases

Abstract

We herein report the case of a 63-year-old woman with an acute spontaneous cervical epidural hematoma who presented with acute hemiparesis and was successfully managed with surgery. Based on a literature review of 50 cases of spontaneous cervical epidural hematomas, we concluded that the relatively high frequency of hemiparesis (12 of 50 cases, 24%) is the result of the fact that epidural hematomas are predominantly distributed dorsolaterally in the region of the mid and lower cervical spine, leading to unilateral cervical cord compression. Clinicians should keep in mind that acute hemiparesis can be caused by spontaneous cervical epidural hematomas for which intravenous thrombolysis is contraindicated. © 2014 The Japanese Society of Internal Medicine.