# Spinal Subdural Hematoma Initially Misdiagnosed, Revealed by CT Brain Window Settings

## TL;DR

A spinal subdural hematoma was misdiagnosed as a stroke but correctly identified using optimized CT imaging techniques.

## Contribution

Highlights the importance of using brain window settings in CT scans to accurately diagnose spinal subdural hematomas.

## Key findings

- A standard trunk CT initially failed to detect the spinal subdural hematoma.
- Re-evaluating the CT with brain window settings revealed the hematoma and confirmed it with MRI.
- The patient had minimal neurological recovery despite prompt surgical intervention.

## Abstract

This case demonstrates that meticulous physical examination and optimized computed tomography (CT) windowing are crucial for diagnosing spinal subdural hematoma (SSH) when it mimics stroke. We present a 43-year-old man with a stroke-like onset of unilateral leg weakness that progressed to paraplegia. While a sensory level at T4 strongly suggested a spinal cord lesion, a standard trunk CT was initially interpreted as normal. The diagnosis of a C7-T4 SSH was ultimately established by re-reviewing the CT using brain window settings and was confirmed by magnetic resonance imaging. Despite emergent surgical decompression, the patient had minimal neurological recovery. This report underscores two key lessons: the diagnostic priority of spinal-specific signs (e.g., a sensory level) over misleading motor deficits, and the utility of applying brain window settings as a simple, effective technique to avoid misdiagnosing this critical condition.