Teaching NeuroImages: Spontaneous Spinal Epidural Hematoma with Spot Sign Positivity

Abstract

An 82-year-old man on warfarin for previous venous thromboembolism presented to the hospital with acute neck pain followed by rapidly progress- ive, asymmetrical incomplete quadriparesis. Cra- niocervical CT angiography (CTA) was performed (figure 1), which revealed a spot sign and hyper- dense material in the cervical spinal canal. MRI confirmed extradural hematoma from C4-T1 (figure 2), and successful surgical management was achieved. The CTA spot sign is a predictor of intracerebral In spinal epidural hematomas, hematoma growth.1 rapid clinical progression has been associated with poorer prognosis.2 data on spot sign positivity in spinal hematomas.