Spontaneous spinal epidural hematoma mimicking acute coronary syndrome: A case report and literature review.

Abstract

Background: Spontaneous spinal epidural hematoma (SSEH) is a rare neurological emergency that can mimic acute myocardial infarction due to overlapping symptoms such as chest and back pain. Misdiagnosis may lead to inappropriate treatments such as anticoagulation, potentially worsening the patient's condition.

Case description: We report a 64-year-old woman with hypertension and a history of breast cancer who presented with chest and upper back pain, accompanied by left arm numbness. Mildly elevated troponin levels led to an initial diagnosis of acute coronary syndrome (ACS). Brain imaging was unremarkable, and coronary angiography revealed normal vessels. However, progressive left-sided hemiparesis and urinary retention prompted cervical magnetic resonance imaging, which revealed a subacute epidural hematoma at the C5-C7 level. Urgent decompressive hemilaminotomy was performed, resulting in gradual neurological recovery. By postoperative day 10, the patient had regained full motor strength.

Conclusion: This case underscores the diagnostic challenges of SSEH presenting with atypical chest symptoms. Clinicians should maintain a high index of suspicion for spinal pathology in patients with axial pain and evolving neurological deficits, even when initial cardiac evaluations are suggestive of ACS. Timely spinal imaging is critical to avoid harmful interventions and enable prompt surgical treatment.