{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T06:13:56Z","timestamp":1776147236240,"version":"3.50.1"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Spontaneous spinal epidural hematoma (SSEH) manifesting acute hemiparesis is a rare stroke mimic that carries a high risk of mismanagement. We present the case of a 52-year-old man who presented with acute right hemiparesis and neck pain, initially diagnosed as an acute ischemic stroke (AIS) and treated with intravenous thrombolysis using tissue plasminogen activator (rt-PA). Persistent neck pain and subsequent urinary retention prompted re-evaluation of the initial cranial computed tomography angiography (CTA), which revealed an epidural hematoma. After limited improvement under 1 week of conservative management, he underwent surgical evacuation on day 12 post-onset, and achieved complete neurological recovery. This case underscores the importance of recognizing neck pain and bladder dysfunction as indicators of spinal pathology in the context of hyperacute stroke. It also demonstrates that delayed surgical intervention may still be effective in carefully selected SSEH patients with slow clinical progression and stable neurological status.<\/jats:p>","DOI":"10.3389\/fmed.2026.1802695","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T05:39:14Z","timestamp":1776145154000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: A patient with spontaneous spinal epidural hematoma misdiagnosed as ischemic stroke recovered after delayed surgery"],"prefix":"10.3389","volume":"13","author":[{"given":"Jianli","family":"He","sequence":"first","affiliation":[{"name":"Xiaolan Clinical Institute of Shantou University Medical College","place":["Zhongshan, Guangdong, China"]},{"name":"Department of Neurology, Xiaolan People\u2019s Hospital of Zhongshan (The Fifth People\u2019s Hospital of Zhongshan)","place":["Zhongshan, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qin","family":"Wang","sequence":"additional","affiliation":[{"name":"Xiaolan Clinical Institute of Shantou University Medical College","place":["Zhongshan, Guangdong, China"]},{"name":"Department of Neurology, Xiaolan People\u2019s Hospital of Zhongshan (The Fifth People\u2019s Hospital of Zhongshan)","place":["Zhongshan, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linna","family":"Jiao","sequence":"additional","affiliation":[{"name":"Xiaolan Clinical Institute of Shantou University Medical College","place":["Zhongshan, Guangdong, China"]},{"name":"Department of Neurology, Xiaolan People\u2019s Hospital of Zhongshan (The Fifth People\u2019s Hospital of Zhongshan)","place":["Zhongshan, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haibo","family":"Su","sequence":"additional","affiliation":[{"name":"Xiaolan Clinical Institute of Shantou University Medical College","place":["Zhongshan, Guangdong, China"]},{"name":"Department of Neurology, Xiaolan People\u2019s Hospital of Zhongshan (The Fifth People\u2019s Hospital of Zhongshan)","place":["Zhongshan, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liang","family":"Jin","sequence":"additional","affiliation":[{"name":"Xiaolan Clinical Institute of Shantou University Medical College","place":["Zhongshan, Guangdong, China"]},{"name":"Department of Anesthesiology, Xiaolan People\u2019s Hospital of Zhongshan (The Fifth People\u2019s Hospital of Zhongshan)","place":["Zhongshan, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,14]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"158","DOI":"10.14444\/7030","article-title":"Spontaneous spinal epidural hematoma: an atypical clinical presentation and discussion of management","volume":"14","author":"Shah","year":"2020","journal-title":"Int J Spine Surg"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"316","DOI":"10.17712\/nsj.2020.4.20200027","article-title":"Acute hemiparesis. A rare presentation of spontaneous spinal epidural hematoma mimicking acute stroke","volume":"25","author":"Huang","year":"2020","journal-title":"Neurosciences (Riyadh)"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"261","DOI":"10.5114\/fn.2022.116940","article-title":"Spontaneous cervical epidural haematoma mimicking stroke: a case report and literature review","volume":"60","author":"Lv","year":"2022","journal-title":"Folia Neuropathol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1016\/j.jns.2009.04.016","article-title":"Spinal epidural hematoma after intravenous thrombolysis for acute ischemic stroke","volume":"284","author":"Yeo","year":"2009","journal-title":"J Neurol Sci"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e9007","DOI":"10.1097\/md.0000000000009007","article-title":"Spontaneous spinal epidural hematoma mimicking transient ischemic attack: a case report","volume":"96","author":"Li","year":"2017","journal-title":"Medicine (Baltimore)"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"157","DOI":"10.25259\/sni_161_2020","article-title":"A spontaneous cervical epidural hematoma mimicking a stroke - a case report","volume":"11","author":"Teles","year":"2020","journal-title":"Surg Neurol Int"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1509903","DOI":"10.3389\/fmed.2025.1509903","article-title":"Case report: a patient with spontaneous spinal epidural hematoma recovered after conservative treatment","volume":"12","author":"Cheng","year":"2025","journal-title":"Front Med (Lausanne)"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1490","DOI":"10.1016\/j.jocn.2011.02.039","article-title":"Spontaneous spinal epidural hematoma","volume":"18","author":"Zhong","year":"2011","journal-title":"J Clin Neurosci"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"574","DOI":"10.5603\/PJNNS.a2021.0066","article-title":"Spontaneous spinal epidural haematoma: management and main risk factors in era of anticoagulant \/ antiplatelet treatment","volume":"55","author":"Stetkarova","year":"2021","journal-title":"Neurol Neurochir Pol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"38","DOI":"10.3171\/spi.2004.100.1.0038","article-title":"Experience in the surgical management of spontaneous spinal epidural hematoma","volume":"100","author":"Liao","year":"2004","journal-title":"J Neurosurg"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1016\/j.surneu.2007.02.019","article-title":"Spontaneous spinal epidural hematoma: analysis of 23 cases","volume":"69","author":"Liu","year":"2008","journal-title":"Surg Neurol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1186\/s13104-017-2969-y","article-title":"Acute on chronic bilateral subdural hematoma presenting with acute complete flaccid paraplegia and urinary retention mimicking an acute spinal cord injury: a case report","volume":"10","author":"Herath","year":"2017","journal-title":"BMC Res Notes"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2017-222686","article-title":"Hemiparesis in spontaneous spinal epidural haematoma: a potential stroke imitator","volume":"2018","author":"Patel","year":"2018","journal-title":"BMJ Case Rep"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"E437","DOI":"10.1097\/brs.0000000000001243","article-title":"Worsening cervical epidural hematoma after tissue plasminogen activator Administration for Stroke like Symptoms","volume":"41","author":"Morimoto","year":"2016","journal-title":"Spine (Phila Pa 1976)"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1097\/NRL.0b013e31823d7ade","article-title":"A case of spontaneous spinal epidural hematoma mimicking a stroke","volume":"18","author":"Son","year":"2012","journal-title":"Neurologist"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1159\/000518525","article-title":"Spontaneous spinal epidural hematoma mimicking stroke and its outcome post intravenous thrombolysis","volume":"51","author":"Szeto","year":"2022","journal-title":"Cerebrovasc Dis"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1212\/wnl.0000000000010511","article-title":"Spontaneous cervical epidural hematoma mimicking acute ischemic stroke","volume":"95","author":"Rahangdale","year":"2020","journal-title":"Neurology"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"143","DOI":"10.3171\/jns.1984.61.1.0143","article-title":"Spontaneous cervical epidural hematoma. A consideration of etiology","volume":"61","author":"Beatty","year":"1984","journal-title":"J Neurosurg"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"S50","DOI":"10.1080\/10790268.2003.11754575","article-title":"International standards for neurological classification of spinal cord injury","volume":"26","author":"Marino","year":"2003","journal-title":"J Spinal Cord Med"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e843","DOI":"10.1212\/wnl.0000000000200844","article-title":"Prognostic factors and treatments efficacy in spontaneous spinal epidural hematoma: a multicenter retrospective study","volume":"99","author":"Peng","year":"2022","journal-title":"Neurology"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e859","DOI":"10.1016\/j.wneu.2023.01.008","article-title":"Ultraearly hematoma evacuation (<12 hours) associated with better functional outcome in patients with symptomatic spontaneous spinal epidural hematoma","volume":"171","author":"Nakamura","year":"2023","journal-title":"World Neurosurg"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1493","DOI":"10.1007\/s00701-022-05130-z","article-title":"Prognostic factors for spontaneous spinal epidural hematoma: a multicenter case-control study","volume":"164","author":"Fukui","year":"2022","journal-title":"Acta Neurochir"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"2415","DOI":"10.21873\/invivo.13710","article-title":"Prognostic factors and treatment efficacy in spontaneous spinal epidural hematoma: a single center experience and literature review","volume":"38","author":"Hsu","year":"2024","journal-title":"In Vivo"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1802695\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T05:39:25Z","timestamp":1776145165000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1802695\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,14]]},"references-count":23,"alternative-id":["10.3389\/fmed.2026.1802695"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1802695","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,14]]},"article-number":"1802695"}}