Ann Rehabil Med.  2013 Feb;37(1):123-126. 10.5535/arm.2013.37.1.123.

Spontaneous Cervical Epidural Hematoma Presenting as Brown-Sequard Syndrome Following Repetitive Korean Traditional Deep Bows

• Seon HJ
• Song MK
• Han JY
• Choi IS
• Lee SG

• KMID: 2266660
• DOI: http://doi.org/10.5535/arm.2013.37.1.123

Abstract

Spontaneous cervical epidural hematoma (SCEH) is an uncommon cause of acute nontraumatic myelopathy. SCEH presenting as Brown-Sequard syndrome is extremely rare. A 65-year-old man had motor weakness in the left extremities right after his mother's funeral. He received thrombolytic therapy under the impression of acute cerebral infarction at a local hospital. However, motor weakness of the left extremities became aggravated without mental change. After being transferred to our hospital, he showed motor weakness in the left extremities with diminished pain sensation in the right extremities. Diagnosis of SCEH was made by cervical magnetic resonance imaging. He underwent left C3 to C5 hemilaminectomy with hematoma removal. It is important for physicians to be aware that SCEH can be considered as one of the differential diagnoses of hemiplegia, since early diagnosis and management can influence the neurological outcome. We think that increased venous pressure owing to repetitive Korean traditional deep bows may be the cause of SCEH in this case.

Keyword

Spinal cervical epidural hematoma; Brown-Sequard syndrome; Hemiplegia

MeSH Terms

Brown-Sequard Syndrome
Cerebral Infarction
Diagnosis, Differential
Early Diagnosis
Extremities
Hematoma
Hemiplegia
Magnetic Resonance Imaging
Sensation
Spinal Cord Diseases
Thrombolytic Therapy
Venous Pressure

Figure

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  Fig. 1 Magnetic resonance images of cervical spine. (A) T1-weighted sagittal image shows isosignal intensity epidural hematoma and compression of cervical spinal cord (arrows), and (B) T2-weighted sagittal image shows a longitudinal high-signal intensity epidural hematoma extending from C2 to C6 vertebrae (arrows). (C) T1-weighted axial image displays an ovoid isosignal intensity epidural hematoma with compression of the spinal cord (arrow), and (D) T2-weighted axial image displays an ovoid high-signal intensity epidural hematoma in the left posterolateral aspect with spinal cord compression (arrows).

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  Fig. 2 Postoperative magnetic resonance images of cervical spine. (A) T2-weighted sagittal image shows swollen spinal cord and intramedullary high signal intensity from C3 to C6 and complete removal of previous cervical epidural hematoma (arrows). (B) T2-weighted axial image displays removal of previous epidural hematoma and evidence of the left C5 partial hemilaminectomy (arrows).

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