Three layers in spinal canal

Contrast-enhanced computed tomography revealed spontaneous spinal epidural hematoma, which mimicked aortic dissection. A 90-year-old woman with a history of hypertension presented to the emergency department at night 3-h sudden neck-to-back pain, followed by loss sensory, motor, and bladder function. She had no prior injury or anticoagulant medication use. At admission, her vital signs were as follows: blood pressure, 210/80 mmHg without any difference in right left arms; pulse rate, 48 beats/min; respiratory 20 breaths/min; temperature, 36.1°C; oxygen saturation, 100% on ambient air. remained lucid throughout stay. General physical examination findings normal. Neurological demonstrated right-dominant paresis, manual muscle testing (right/left) indicating biceps 2/4 iliopsoas 2/3. The patient also exhibited dysesthesia distal upper lower extremities but thermal hypoalgesia was observed. Deep tendon reflex indicated an increased reflex. Cerebral neurological Blood tests showed elevated D-dimmer level 2.9 μg/mL (reference range <1.0) other laboratory data within normal limits. Suspecting dissection (AD), night-shift doctor performed urgent contrast-enhanced (CT), did not reveal false lumen. Although cause symptoms unknown, she admitted for follow-up. On following day, patient's persisted improvement. hospitalist, who taken over care from previous on-duty physician, reviewed day's CT scan. In reconstructed sagittal view, space-occupying lesion extravasation C4 identified (Figure 1), suggested diagnosis hematoma (SSEH). To confirm diagnosis, magnetic resonance imaging (MRI) performed. T2-weighted (T2WI) MRI three-layered structure T6 canal, consisting cord (hypo-intense), fluid (hyper-intense), (iso-intense) ventral, consistent SSEH 2). Despite delay laminectomy drainage 24 hours onset largely resolved. is rare serious treatable disease that presents pain progressive paralysis.1, 2 Its peak incidence 60s, it almost evenly distributed between genders.1 Hypertension therapy have been frequent risk factors remains unknown approximately half cases.2 typically diagnosed can be detected CT, this case. paralysis mimic presentation AD stroke,3, 4 leading delayed incorrect diagnosis. When there are still some inconsistencies after scan suspected has found dissection, canal should examined. All authors received specific grant funding agency public, commercial, not-for-profit sectors. stated explicitly conflicts interest connection article. obtained consent.