Cervical ligamentum flavum hematoma presenting with tetraparesis in a patient with Parkinson’s disease: A case report

Background: Ligamentum flavum hematoma (LFH) is a rare cause of spinal cord and nerve root compression that typically occurs in the lumbar spine. Cervical involvement is exceedingly rare and can be difficult to distinguish from other dorsal epidural lesions. Case Description: A 70-year-old man with Parkinson’s disease developed incomplete tetraparesis and bladder and bowel dysfunction following recurrent minor falls. Magnetic resonance imaging (MRI) showed a dorsal epidural lesion at C4–5. Surgery was delayed for 10 days because of a concurrent bilateral pulmonary embolism, which required initial anticoagulation. The patient underwent a C3 partial laminectomy and C4–6 double-door laminoplasty. A hematoma was found within the ligamentum flavum; a preserved ventral layer of the ligament separated the clot from the dura. Histopathological examination confirmed an intraligamentous hematoma with degenerative changes. Postoperatively, the tetraparesis improved, with no recurrent symptoms at 6 months. Conclusions: Cervical LFH is a rare but important differential diagnosis for dorsal epidural lesions. As MRI findings are often nonspecific, histopathological confirmation after surgical resection is warranted.