ABSTRACT NUMBER: ESOC2026A978 SPONTANEOUS SPINAL EPIDURAL HEMATOMA MIMICKING ACUTE ISCHEMIC STROKE IN A PATIENT TAKING CLOPIDOGREL

Abstract Background and aims The frequency of spontaneous spinal epidural hematoma is < 1%, which usually manifests with neck pain along with paraparesis or tetraparesis, but hemiparesis is an atypical symptom. In routine clinical practice, up to 20-25% of cases can mimic stroke, and may lead to negative outcomes, if we administer anticoagulant/antiplatelet treatments. Methods 70-year-old woman with hypertension, and TIA, treated with clopidogrel and losartan. She presents with sudden neck pain accompanied by weakness on the right side of his body, which began about 7 hours ago. Physical examination: Blood pressure (BP) 170/90 mmHg, distal hemiparesis in the right upper limb 4/5, and ipsilateral lower limb plegia, with a left-sided sensory level of T2. Osteotendinous reflexes were brisk on the left side. Results Cervical spine MRI: spinal epidural hematoma from C4 -T1, causing severe canal stenosis at the C5-C6 level. It displaces and compresses the spinal cord to the left. Once BP is under control, and after administration of platelet pool due to clopidogrel intake, a C5-C6 laminectomy is performed with evacuation of the hematoma. Conclusions There are few cases in the literature on the relationship between clopidogrel and spontaneous spinal epidural hematoma, although this could be a precipitating factor. In our patient, antiplatelet therapy coincided with high blood pressure as possible triggers. Clinical management must be urgent surgical evacuation of the hematoma. This case highlights the importance of including cervical spinal cord pathology in the etiological diagnostic of patients with acute hemiparesis, to avoid inappropriate acute stroke treatments. Conflict of interest Pilar: nothing to disclose Figure 1 - belongs to Conclusions