Investigation and Treatment
On admission to the emergency hospital, her blood pressure was 152/82mmHg and pulse was 60/min. She had mild delirium. Routine blood analysis showed renal function tests were raised (blood urea nitrogen 28.0mg/dl and serum creatinine 2.11mg/dl). Serum electrolytes ware normal.
Brain MR imaging showed left occipital white matter and left cerebellum slight hyperintensities on fluid-attenuated inversion recovery (FLAIR)-sequences (Fig.1 a). MR imaging of the spine showed a large epidural hematoma compressing the dorsolateral surface of spinal cord at the levels C2-Th4 (Fig.1 c-d) and intramedullary hematoma at C4/5 (Fig.1 e). No abnormally enlarged vessels were observed on T2 weighted image.
Next day, on admission to our hospital, she was still confused, and her clinical findings were not improved. Brain and spinal MR performed, spinal epidural hematoma was not decreased and white matter of right temporooccipital lobes and cerebellum FLAIR high lesions were revealed clearly (Fig.1 b). She underwent a C3-T1 hemi-laminectomy and removal of epidural hematoma.