CERVICAL SPINAL EPIDURAL HEMATOMA - THE DOUBLE JEOPARDY

Spontaneous spinal epidural haematoma is an unusual but well recognize d cause of compressive myelopathy or cauda equina syndrome. Radicular pain is one of the earliest symptoms and a hallmark of spontaneous spi nal epidural haematoma, as in the case of cervical spondylosis and dis c prolapse, Should an epidural haematoma be located in the cervical sp ine, the resultant cervical radicular pain may sometimes be erroneousl y attributed to a cardiac cause, especially in the setting of pre-exis ting cardiac disease. The error in diagnosis can lead to another pitfa ll, the addition of heparin, If the etiology of the pain is a cervical epidural haematoma this can have grave consequences. Moreover, patien ts with cardiac ischaemia who are treated with anticoagulants may rare ly develop a cervical epidural haematoma, The resulting radicular pain can overlap with cardiac pain and escape recognition, Symptoms of nec k and upper extremity pain with bilateral signs of myelopathy with a s ensory level should lead to a suspicion of acute cervical cord compres sion, The addition of heparin can only compound the disastrous consequ ence of a rapidly expanding spinal epidural haematoma. The following c ases illustrate this diagnostic and therapeutic conundrum.