A 75-YEAR-OLD woman had severe pain in the posterior area of her neck and shoulder and a slight right-sided hemiparesis. She had a 5-year history of angina pectoris and atrial fibrillation and had taken warfarin sodium for more than 5 years to prevent embolic events. She had also had a minor ischemic stroke at age 65 years. Neurological examination findings revealed a slight right-sided hemiparesis with hypesthesia to touch and pain in the right upper extremity. There was no unilateral facial paralysis. Her deep tendon reflexes were symmetrical bilaterally, and a Babinski sign was present in the right tendon. Routine laboratory testing revealed a prolonged prothrombin time of 21.9 seconds (international normalized ratio, 2.05). An electrocardiogram showed atrial fibrillation; there were no signs of cardiac ischemia. A computed tomographic scan of the brain revealed no abnormalities. The patient was admitted with the presumptive diagnosis of embolic cerebrovascular accident. Because the prothrombin time was elevated secondary to warfarin treatment, additional antiplatelet therapy was started.
Sakamoto N, Yanaka K, Matsumaru Y, Nose T. Cervical Epidural Hematoma Causing Hemiparesis. Arch Neurol. 2003;60(5):783. doi:10.1001/archneur.60.5.783