脳卒中と誤診されやすい脊髄硬膜外血腫

Clinical Manifestations of Spinal Epidural Hematoma-Stroke Mimic and Pitfalls in Diagnosis

脊髄硬膜外血腫の臨床を概説し，自験例を含め特徴を述べた。本症と脳卒中の類似点を議論した論文をレビューし問題点を整理した。本症は初診時に片麻痺を呈する例が多く，脳卒中と誤診しやすく，実際に抗血栓療法を受けた症例も多数報告されている。t-PA投与の適応は時間制限があるため，時間を急ぐあまり本症を見落とす危険がある。特徴である頸部の疼痛やブラウン-セカール症候群，ホルネル症候群などに注目することが診断に重要である。

Abstract

Clinical manifestations of spinal epidural hematoma are presented, and the cases mimicking acute ischemic stroke have been reviewed from the literature. Many reports described the cases of spinal epidural hematoma with acute hemiparesis mimicking ischemic stroke in which intravenous thrombolytic treatment with recombinant tissue plasminogen activator was considered. A correct diagnosis of acute ischemic stroke must be made within 4.5 hours from the onset of symptoms, a relatively short window period. A spinal epidural hematoma is a potentially important stroke mimic in a wide variety of conditions that mimic a stroke. The literature review and discussion will emphasize allowing the distinction between these hemiparetic presentation of spinal epidural hematoma and acute ischemic stroke. A spinal epidural hematoma should be considered in the differential diagnosis of patients with acute onset of hemiparesis when associated with neck pain and signs of Horner's syndrome and Brown-Sēquard syndrome.