PDF(Pubmed)
Abstract：
Accurate differentiation between epidural hematomas and lumbar disc extrusion is essential due to the potential overlap in clinical presentations. We present a case report highlighting a significant challenge in which a massive lumbar disc extrusion was mistaken for an epidural hematoma. This is a case report of a 38-year-old male patient who developed cauda equina syndrome four days after experiencing an audible cracking in the lower back during weightlifting activity. Magnetic resonance imaging (MRI) was inconclusive, unable to distinguish between an extruded nucleus pulposus and a spinal epidural hematoma. Subsequently, an urgent operation revealed a large herniated disc at the L4-L5 level, ruling out any hematoma. The patient\'s post-operative follow-up showed significant improvement, with almost complete recovery of motor and sensory functions. This case emphasizes the challenges faced when distinguishing between epidural hematomas and lumbar disc herniations, particularly on MRI. The lumbar disc herniation\'s substantial size, cranial and caudal migration on multiple levels, and signal intensity contributed to the misdiagnosis, underscoring the importance of careful interpretation and awareness of such complexities.
摘要：
由于临床表现可能重叠，因此必须准确区分硬膜外血肿和腰椎间盘突出症。我们提供了一个病例报告，强调了一个重大挑战，其中大量的腰椎间盘突出被误认为是硬膜外血肿。这是一例38岁的男性患者的病例报告，该患者在举重活动期间腰部有声音破裂四天后患上了马尾综合症。磁共振成像（MRI）尚无定论，无法区分髓核挤压和脊髓硬膜外血肿。随后，紧急手术显示L4-L5级的大椎间盘突出,排除任何血肿.患者术后随访显示明显改善,运动和感觉功能几乎完全恢复。这个案例强调了在区分硬膜外血肿和腰椎间盘突出症时所面临的挑战,尤其是MRI。腰椎间盘突出症的体积很大,颅骨和尾骨在多个层面上迁移，信号强度导致了误诊，强调仔细解释和意识到这种复杂性的重要性。
