Spontaneous cervical epidural hematoma treated by the combination of surgical evacuation and steroid pulse therapy

Abstract

A 70-year-old man on antiplatelet therapy developed sudden severe back pain in his neck with numbness and weakness in his extremities; On admission he presented with complete quadriplegia, hypoesthesia, and anuria. Magnetic resonance imaging (MRI) revealed cervical cord compression due to an epidural hematoma posterior to the spinal cord, and intramedullary hyperintensity. Surgical evacuation was performed about 12 hours after the onset, but the recovery of neurological deficits was poor. After performing 2 additional administrations of steroid pulse therapy, the patient's motor dysfunction began to improve and spinal MRI showed a recovery as well. These observations suggest that steroid administration should be considered as a post-operative additional therapy for cases with severe neurological deficits even after surgery. © 2008 The Japanese Society of Internal Medicine.