Acta Neurochir (Wien) (2004) 146: 1161–1163 DOI 10.1007/s00701-004-0347-8 Brief Report of Special Case Spinal shock in spontaneous cervical spinal epidural haematoma D. T. M. Chan 1 , R. Boet 1 , W. S. Poon 1 , F. Yap 2 , and Y. L. Chan 3 1 Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China 2 Department of Intensive Care and Anaesthesiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China 3 Department of Diagnostic Radiology and Organ Imaging, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China Published online August 16, 2004 # Springer-Verlag 2004 Summary A young man presented with quadriparesis and spinal shock because of a spontaneous cervical spinal epidural haematoma was reported. Immediate MRI diagnosis followed by emergency decompression with six hours of presentation resulted in complete recovery. Keywords: Spinal epidural haematoma; spinal shock. Introduction Spontaneous spinal epidural haematoma causing cord compression is a neurosurgical emergency. An urgent operative decompression is the standard treatment. Clin- ical presentation and examination usually localize the level of the lesion (e.g. cervical or thoraco-lumbar region). A magnetic resonance imaging (MRI) is the cornerstone of accurate diagnosis. The literatures sug- gests the earlier a decompression, the better the neuro- logical recovery and outcome. We would like to illustrate the importance of this point with a case of spontaneous cervical epidural haematoma, where the patient had a complete neurolog- ical recovery from profound deficits. Case report A 37 year-old gentleman complained of sudden onset of posterior neck pain at 10:30, followed by rapid progression of 4-limb numbness and weakness within the next 30 minutes. He managed to phone his mother for help. Five minutes later, his mother arrived and found him lying on the floor due to the profound limb weakness. An ambulance brought him to the Emergency Room at 12:11. On arrival, he was fully alert and complained of neck pain and interscapular pain. He denied any preceding injuries or drug intake. His blood pressure was low (70=40 mmHg) with bradycardia (Pulse 40=minute). There was complete flaccid tetraplegia, absent reflexes and the loss of anal sphincteric control. The sensory deficit was at C4 level (supraclavicular region). An X-ray of the cervical spine showed no malaligment or fracture. The respiratory rate was 16 per minute and his arterial oxygen saturation was 99% in room air. A diagnosis of spinal shock with the lesion at the C4 cervical level was made. The patient was immediately resuscitated in the Emergency Room. His hypotension was reversed by fluid loading, Atropine and Metaram- inal bitartrate. An urgent MRI was arranged immediately at 13:00. An MRI of the cervical spine showed a C3C4 level right posterolateral epidural haematoma causing cord compression (Figs. 1, 2). An MR angiogram however did not reveal any vascular lesion. He underwent surgery immediately for C3=4 Laminectomy and clot evacuation for decompression. The decompression was achieved at 15:30. By 17:00, he had already regained full consciousness. Physical examination at the time indicated a remarkable improvement, com- pared with the pre-operative assessment. There was a return of normal sensation and anal sphincteric control. The muscle power of all his limbs was grade 3=5. By the next day, his muscle power had returned to normal, and there were no other neurological deficits. The patient’s personal history showed no bleeding tendency, nor an excessive ingestion of dietary garlic. There was no family history of haemato- logical disease. His clotting profile and platelet counts were all normal. He made an uneventful recovery and was discharged 3 days after the operation. Discussion Acute spontaneous spinal epidural haematoma is a rare condition. This was first described by Jackson in