頚髄硬膜外血腫

Cervical Spinal Epidural Hematoma

Point

・特発性頚髄硬膜外血腫は，突然の頚部痛と片側性の脊髄圧迫症状で発症することが多く，脳血管障害と誤診されることがある．

・片麻痺および頚部痛を来す鑑別疾患として，動脈解離や血管炎症候群などの頭蓋外血管病変も重要である．

・片麻痺を呈する症例で頚部痛を伴う場合は，頭蓋内評価のほかに頚部病変の評価も必要と考えられる．

　A woman in her 60s was admitted to our hospital because of sudden-onset right hemiparesis, paresthesia, and neck pain. At first, a head CT scan was performed to rule out stroke, which did not detect any abnormalities. Subsequently, a neck CT scan was performed, which revealed a mild high-density structure compressing the dural sac within the cervical spinal canal. She was suspected to have a spinal hematoma. A MRI scan revealed a spindle-shaped structure with a heterogeneous high signal on T2-weighted and a mild high signal on T1-weighted sagittal images, which led to the diagnosis of a spontaneous spinal epidural hematoma. The patient was treated with conservative therapy upon which her symptoms improved. She was discharged seven days after admission.

　Spontaneous cervical spinal epidural hematoma often causes neck pain followed by unilateral spinal cord compression symptoms（such as hemiparesis and paresthesia）and can be misdiagnosed as a stroke. In cases of hemiparesis with sudden-onset neck pain, cervical lesions should be considered in the differential diagnoses in addition to stroke.