Spinal Subdural Hematoma Initially Misdiagnosed, Revealed by CT Brain Window Settings

This case demonstrates that meticulous physical examination and optimized computed tomography (CT) windowing are crucial for diagnosing spinal subdural hematoma (SSH) when it mimics stroke. We present a 43-year-old man with a stroke-like onset of unilateral leg weakness that progressed to paraplegia. While a sensory level at T4 strongly suggested a spinal cord lesion, a standard trunk CT was initially interpreted as normal. The diagnosis of a C7-T4 SSH was ultimately established by re-reviewing the CT using brain window settings and was confirmed by magnetic resonance imaging. Despite emergent surgical decompression, the patient had minimal neurological recovery. This report underscores two key lessons: the diagnostic priority of spinal-specific signs (e.g., a sensory level) over misleading motor deficits, and the utility of applying brain window settings as a simple, effective technique to avoid misdiagnosing this critical condition.