Spinal Cord Infarction Presented as Hemiparesis that Could be Mistaken for Caused by Chronic Subdural Hematoma: A Case Report

Spinal cord infarction (SCI) is a rare condition that is frequently misdiagnosed due to its nonspecific or overlapping neurological symptoms. In contrast, chronic subdural hematoma (CSDH) is relatively common, but can present with diverse manifestations, occasionally including hemiparesis. Accurate differentiation is crucial, as the management strategies for these two conditions differ significantly. We report a 69-year-old woman who presented with left hemiparesis (Medical Research Council grade 4) of 3 days' duration. Initial brain computed tomography revealed a right-sided CSDH with mild brain compression, and hematoma evacuation was initially planned. However, a detailed neurological examination revealed radiating pain and dysesthesia in the left upper extremity, raising suspicion of a spinal origin. Emergency cervical magnetic resonance imaging (MRI) revealed T2 hyperintensity and cord swelling at the C4-5 level, with contrast enhancement but no diffusion restriction on diffusion-weighted imaging. These findings suggested SCI, and surgery was deferred in favor of conservative management. Follow-up MRI performed two months later confirmed diffusion restriction and partial resolution of the lesion, establishing the diagnosis of SCI. This case highlights the diagnostic challenge of differentiating central from spinal causes of hemiparesis in the presence of CSDH. A thorough neurological assessment and early spinal imaging are essential to prevent unnecessary surgical intervention and to optimize the management of SCI.