Post‐Acupuncture Acute Cervical Spinal Epidural Hematoma With Hemiplegia Misdiagnosed as Cerebral Infarction: A Case Report and Literature Review

TL;DR

A rare case of spinal hematoma after acupuncture was initially mistaken for a stroke, highlighting the need for careful diagnosis and suggesting conservative treatment can be effective.

Contribution

Highlights paACSEH as a critical differential diagnosis and suggests conservative treatment may be preferable in certain cases.

Findings

Misdiagnosis of paACSEH as cerebral infarction can lead to inappropriate thrombolytic therapy.

Conservative management can lead to favorable outcomes when neurological stabilization occurs.

Early neurological improvement may indicate better recovery with non-surgical approaches.

Abstract

This case report describes a rare but serious complication termed post‐acupuncture acute cervical spinal epidural hematoma (paACSEH). The patient presented with right‐sided hemiplegia and cervical pain following acupuncture therapy. Initial misdiagnosis as cerebral infarction led to inappropriate alteplase thrombolytic therapy, which was promptly discontinued after CT imaging confirmed cervical spinal epidural hematoma. Given the patient's concurrent clopidogrel therapy and recent thrombolysis, surgical intervention was considered high‐risk for rebleeding. Conservative management was subsequently adopted due to neurological stabilization, resulting in favorable clinical outcomes. This case underscores the critical importance of considering paACSEH in patients with: (1) recent cervical acupuncture history; and (2) acute neurological deficits (particularly hemiplegia with cervical pain in the absence of speech or consciousness impairment). Our findings suggest that conservative treatment may yield satisfactory recovery, potentially with faster functional restoration than surgical intervention, in cases demonstrating early neurological improvement or having surgical contraindications.

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