Cervical Epidural Hematoma

Still More Weakness

Step 1: View clinicals

A 71 year old woman presents with rapidly progressive weakness of her right upper and lower limbs for 1 hour, along with pain in the back of her neck. There was no history of antecedent trauma. Her medical history is significant only for hypertension for 5 years, which is well controlled on ramipril alone. A random capillary glucose is found to be 130 mg/dl, as is her electrolyte profile, renal functions and liver functions.

Step 2: Order all relevant investigations

Lumbar Puncture

You realize that a lumbar puncture might not be a good idea.

MRI + MRA Brain

The MRI scan of the brain reveals no features suggestive of hemorrhage or infarction; MRA reveals no features suggestive of arterial dissection.

MRI Cervical Spine

The MRI of the cervical spine reveals a longitudinal posterior epidural hematoma compressing the spinal cord at the levels C4 to T1.

Coagulation Profile

INR: 1.0 (0.9 - 1.1) APTT: 32 sec (30 - 40) TT: 12 sec (12 - 14) Platelet Count: 320,000/mm3 (150,000-450,000)

Step 3: Select appropriate management

Neurosurgical Referral

Score: ★★☆