1
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Liu J, McHugh F, Li Y. Spinal subdural haemorrhage secondary to strenuous exercise and warfarin, complicated by acute ischaemic stroke. BMJ Case Rep 2024; 17:e258729. [PMID: 38442981 PMCID: PMC10916092 DOI: 10.1136/bcr-2023-258729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
Spinal subdural haemorrhage or haematoma (SSDH) is a rare condition that is often overlooked and missed on initial presentation due to its non-specific features that may mimic other more common pathologies. It is associated with high morbidity and mortality rates, with few evidence-based management principles, particularly during the subacute stages of recovery. In this report, we detail a case of SSDH associated with exercise and anticoagulation therapy, which was complicated by acute ischaemic stroke. SSDH should be suspected in cases of acute back pain without a clear alternative cause, particularly in coagulopathic individuals. Following treatment, early recommencement of anticoagulation therapy may be justified in certain cases where indicated, after careful consideration of the affected individual's risk profile.
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Affiliation(s)
- James Liu
- Neurosurgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Frances McHugh
- Neurosurgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Yingda Li
- Neurosurgery, Westmead Hospital, Westmead, New South Wales, Australia
- The University of Sydney School of Medicine, Sydney, New South Wales, Australia
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2
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Ahrari I, Jamali M, Mohammadi S, Ghavipisheh M, Eghbal K, Saffarian A, Rahmanian A, Ghahramani S, Taheri R. Spontaneous idiopathic spinal subdural hemorrhage in a 16-year-old boy: A rare case in pediatrics and review of literature. Clin Case Rep 2023; 11:e6993. [PMID: 36852126 PMCID: PMC9957699 DOI: 10.1002/ccr3.6993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 01/21/2023] [Accepted: 02/07/2023] [Indexed: 02/27/2023] Open
Abstract
Idiopathic spinal subdural hematoma (SSDH) is a rare phenomenon. Here, we present a 16-year-old-boy who presented with acute sudden onset weakness and brown squared syndrome; the cervical MRI findings showed acute subdural hematoma from C2 to C6. Emergent surgical intervention was performed, and significant improvement was seen in follow-ups.
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Affiliation(s)
- Iman Ahrari
- Department of NeurosurgeryShiraz University of Medial SciencesShirazIran
| | - Mohamad Jamali
- Department of NeurosurgeryShiraz University of Medial SciencesShirazIran
| | - Somayeh Mohammadi
- Department of Anesthesiology, Preoperative and Pain Medicine, Brigham and Woman's HospitalHarvard Medical SchoolBostonMAUSA
| | - Mahsa Ghavipisheh
- Department of PsychiatryShiraz University of Medial SciencesShirazIran
| | - Keyvan Eghbal
- Department of NeurosurgeryShiraz University of Medial SciencesShirazIran
| | - Arash Saffarian
- Department of NeurosurgeryShiraz University of Medial SciencesShirazIran
| | | | - Soulmaz Ghahramani
- Health Policy Research Center, Institute of HealthShiraz University of Medical SciencesShirazIran
| | - Reza Taheri
- Department of NeurosurgeryShiraz University of Medial SciencesShirazIran
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3
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Dezawa T, Hasegawa K, Tsuge S, Wada A, Takahashi H. A Case of Idiopathic Thoracic Spinal Subdural Hematoma With Bilateral Lower Limb Paralysis. Cureus 2021; 13:e16585. [PMID: 34430177 PMCID: PMC8378316 DOI: 10.7759/cureus.16585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 12/02/2022] Open
Abstract
Subdural hemorrhage is rare and is mostly triggered non-traumatically due to intracranial surgery, lumbar puncture, anticoagulant therapy, blood diseases, vascular malformations, and tumors. We experienced a case of idiopathic subdural hematoma with acute bilateral lower limb paralysis on postoperative day 4 after laparoscopic hysteromyomectomy. The patient was a 40-year-old woman with uterine myoma who took no medication nor had history of trauma or abnormalities such as vascular malformations. Four days after laparoscopic surgery, sudden chest and back pain and bilateral lower limb paralysis appeared. Muscle weakness was found predominantly on the left side. In manual muscle test (MMT), the quadriceps femoris was 5/5 on both sides, but the tibialis anterior, extensor pollicis longus and flexor pollicis longus were 5/5 only on the right, and 2/5 on the left side. Warm pain sensation was decreased below Th4 (Fourth thoracic vertebra), and the right side showed a greater decrease of deep sensation than the left. Excretion was difficult and dysuria was also apparent. There were no abnormalities in blood biochemical tests or in the blood coagulation system. Using the results of diagnostic imaging, as preoperative diagnosis of the patient, spinal subdural hematoma was suspected. Conservative treatment was initially conducted but the emergency surgery for hematoma removal was performed at 14 hours after the onset because of progression of paralysis. This resulted in improvement of neurological symptoms including lower limb paralysis, bladder-rectal disorder and hypoesthesia. If subdural hematoma is suspected regardless of the cause, it is important to observe neurological findings over time and make a quick decision to treat with surgery.
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Affiliation(s)
- Takashi Dezawa
- Department of Orthopaedic Surgery, Toho University School of Medicine, Tokyo, JPN
| | - Keiji Hasegawa
- Department of Orthopaedic Surgery, Toho University School of Medicine, Tokyo, JPN
| | - Shintarou Tsuge
- Department of Orthopaedic Surgery, Toho University School of Medicine, Tokyo, JPN
| | - Akito Wada
- Department of Orthopaedic Surgery, Toho University School of Medicine, Tokyo, JPN
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, Toho University School of Medicine, Tokyo, JPN
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Xu Q, Wang Y, Wang D, Xu B, Yu Z, Yin X, Lang D. Spontaneous Spinal Subdural Hematoma after Percutaneous Mechanical Thrombectomy Combined with Catheter-Directed Thrombolysis for Deep Venous Thrombosis: A Case Report. Ann Vasc Surg 2020; 66:670.e1-670.e4. [PMID: 31978482 DOI: 10.1016/j.avsg.2020.01.078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/23/2019] [Accepted: 01/02/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Percutaneous mechanical thrombectomy combined with catheter-directed thrombolysis is one of the most important methods for deep venous thrombosis treatment. Spontaneous spinal subdural hematoma is a remarkably rare complication in the thrombolysis process with catastrophic consequences, as shown in this case report. METHODS Percutaneous mechanical thrombectomy, percutaneous angioplasty, and catheter-directed thrombolysis were performed for the patient. Postoperatively, the patient was diagnosed with spontaneous spinal subdural hematoma and received a series of medical treatments and surgical interventions. RESULTS The patient was still paraplegic and incontinent at the postoperative 7-month follow-up. CONCLUSIONS Neurologic symptoms must be monitored carefully both during and after the thrombolysis procedure. The onset of spinal neurologic deficits in any patient must raise the suspicion that a spinal subdural hematoma has occurred. Surgical decompression beyond 24 hr may cause permanent neurological damage.
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Affiliation(s)
- Qiyang Xu
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No.2 Hospital), Ningbo, Zhejiang, China
| | - Yi Wang
- Department of Radiotherapy and chemotherapy, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No.2 Hospital), Ningbo, Zhejiang, China
| | - Di Wang
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No.2 Hospital), Ningbo, Zhejiang, China
| | - Bin Xu
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No.2 Hospital), Ningbo, Zhejiang, China
| | - Zuanbiao Yu
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No.2 Hospital), Ningbo, Zhejiang, China
| | - Xiaoliang Yin
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No.2 Hospital), Ningbo, Zhejiang, China
| | - Dehai Lang
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No.2 Hospital), Ningbo, Zhejiang, China.
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Rothrock RJ, Li AY, Rumsey J, Fifi JT, Kellner CP, Roonprapunt C. Aneurysmal Subarachnoid Hemorrhage with Spinal Subdural Hematoma: A Case Report and Systematic Review of the Literature. World Neurosurg 2019; 128:240-247. [PMID: 31103768 DOI: 10.1016/j.wneu.2019.05.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 05/08/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Spinal subdural hematoma (S-SDH) rarely occurs after aneurysmal subarachnoid hemorrhage (SAH). Little information is known regarding the management and prognosis of patients with both S-SDH and SAH. Here, we present an illustrative case and provide a systematic review of S-SDH in the setting of SAH. METHODS A systematic literature review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines revealed 11 previous cases of concurrent intracranial SAH and spinal SDH, which are presented with our new reported case. RESULTS Intracranial sources of spontaneous SAH included 8 aneurysms, 1 pseudoaneurysm, and 3 angiogram-negative cases. Hunt Hess grades ranged from 1 to 4, mean time between SAH and S-SDH was 5.8 days, and S-SDH presented most frequently in the lumbar spine. Eight patients showed significant to complete clinical recovery, 2 had continued plegia of the lower extremities, and 2 expired. Modified Rankin scores (mRS) ranged from 0 to 6, with mRS >2 for 4 of 12 patients. Patients with a poor clinical outcome (mRS >2) had an initially negative cerebral angiogram, earlier presentation with less time between SAH and S-SDH (0.8 vs. 7.6 days), use of antithrombotic medication, no diversion of cerebrospinal fluid, and cervical or thoracic S-SDH. CONCLUSION S-SDH is uncommon in the setting of aneurysmal SAH; better outcomes are associated with lumbar location, delayed presentation, cerebrospinal fluid diversion, and lack of antithrombotic use. Conservative treatment may be sufficient in patients with delayed S-SDH and lack of significant neurologic deficits. More reported cases will allow greater understanding of this clinical entity.
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Affiliation(s)
- Robert J Rothrock
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Adam Y Li
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jamie Rumsey
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Johanna T Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christopher P Kellner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Chan Roonprapunt
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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6
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Atypical Presentation of Atraumatic Spinal Subdural Hematoma Associated with Warfarin: A Case Report and Review of the Literature. Case Rep Orthop 2019; 2019:4037916. [PMID: 31236299 PMCID: PMC6545747 DOI: 10.1155/2019/4037916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/24/2019] [Accepted: 05/05/2019] [Indexed: 12/02/2022] Open
Abstract
Nontraumatic spinal subdural hematomas secondary to anticoagulants are remarkably rare. A case of spontaneous, atraumatic subdural hematoma involving the thoracic region in an 80-year-old woman on warfarin is reported. The patient presented with gross motor and sensory loss, delayed onset of incontinence, and no other symptoms. An MRI suggested an epidural hematoma concentrated around the T4-T9 levels. She was taken emergently to the OR approximately 30 hours after the initial onset of symptoms for a T3-T11 laminectomy. No epidural hematoma was noted. However, discoloration and bulging of the thecal sac were noted, and the dura was incised longitudinally from T2 to T10 revealing an expansive jelly-like blood clot which was evacuated. Postoperatively, the patient had regained 1/2 sensory function in the bilateral lower extremities. At the 2-week mark, the patient was still incontinent and showed 2/2 sensory and 2/5 motor functions in select muscle groups in her bilateral lower extremities. Completely nontraumatic, spontaneous subdural hematomas of the spine are very rare, and early surgical decompression within 24 hours from symptom onset may allow neurological recovery. Large extensive laminectomies up to 10 thoracic levels have been shown to be safe and effective in a few cases, including our case.
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7
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Acute idiopathic spinal subdural hematoma: What to do in an emergency? Neurochirurgie 2019; 65:93-97. [DOI: 10.1016/j.neuchi.2018.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 08/16/2018] [Accepted: 10/06/2018] [Indexed: 11/20/2022]
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8
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Uto T, Yonezawa N, Komine N, Tokuumi Y, Torigoe K, Koda Y, Tsuchiya H. A delayed-onset intracranial chronic subdural hematoma following a lumbar spinal subdural hematoma: A case report. Medicine (Baltimore) 2018; 97:e12479. [PMID: 30235747 PMCID: PMC6160060 DOI: 10.1097/md.0000000000012479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE A spinal subdural hematoma (SDH) is rarely complicated with an intracranial SDH. We found only 7 cases of spontaneous concurrent lumbar spinal and cranial SDHs, in which lumbar symptoms occurred before head symptoms. PATIENT CONCERNS We describe a 77-year-old man with spontaneous concurrent spinal and cranial SDHs, in whom the spinal SDH was identified 30 days before the intracranial chronic SDH. DIAGNOSIS Magnetic resonance imaging showed a spinal SDH at L4/L5. There was no paralysis, and the patient was managed conservatively. About 30 days after the onset of back pain, he experienced tinnitus and visual hallucination. Brain computed tomography showed a chronic SDH and midline shift. INTERVENTIONS Burr-hole evacuation was performed, and the patient's condition improved. OUTCOMES At 5 months of follow-up, there was no recurrence of the spinal or intracranial SDH. LESSONS It is important to consider the possibility of intracranial hemorrhage when a spinal SDH is identified.
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MESH Headings
- Aged
- Hematoma, Subdural, Chronic/complications
- Hematoma, Subdural, Chronic/diagnostic imaging
- Hematoma, Subdural, Intracranial/diagnostic imaging
- Hematoma, Subdural, Intracranial/etiology
- Hematoma, Subdural, Spinal/complications
- Hematoma, Subdural, Spinal/diagnostic imaging
- Humans
- Magnetic Resonance Imaging
- Male
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Affiliation(s)
| | | | | | | | | | - Yukihiko Koda
- Department of Neurosurgery, Asanogawa General Hospital, Ishikawa
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Ishikawa, Japan
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Wang Y, Zheng H, Ji Y, Lu Q, Li X, Jiang X. Idiopathic Spinal Subdural Hematoma: Case Report and Review of the Literature. World Neurosurg 2018; 116:378-382. [DOI: 10.1016/j.wneu.2018.05.155] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/20/2018] [Accepted: 05/22/2018] [Indexed: 12/29/2022]
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10
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Acute, Nontraumatic Spontaneous Spinal Subdural Hematoma: A Case Report and Systematic Review of the Literature. Case Rep Neurol Med 2017; 2017:2431041. [PMID: 29441210 PMCID: PMC5758945 DOI: 10.1155/2017/2431041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 12/04/2017] [Indexed: 12/03/2022] Open
Abstract
Spontaneous spinal subdural hematoma (sSDH) is a rare condition outright. Moreover, cases that occur spontaneously in the absence of an identifiable etiology are considerably less common and remain poorly understood. Here, we present the case of a 43-year-old man with spontaneous sSDH presenting with acute onset low back pain and paraplegia. Urgent magnetic resonance imaging identified a dorsal SDH from T8 to T11 with compression of the spinal cord. Emergent T8–T10 laminectomies with intradural exploration and hematoma evacuation were performed. However, despite prompt identification and appropriate action, the patient's recovery was modest and significant disability remained at discharge. This unique and unusual case demonstrates that spontaneous sSDH requires prompt surgical treatment to minimize associated morbidity and supports the association between the presence of severe neurological deficits upon initial presentation with less favorable outcomes. We performed a comprehensive systematic review of spontaneous sSDH of unknown etiology, which demonstrates that emergent surgical intervention is indicated for patients presenting with severe neurological deficits and the presence of these deficits is predictive of poor neurological outcome. Furthermore, conservative management should be considered in patients presenting with mild neurological deficits as spontaneous resolution followed by favorable neurological outcomes is often observed in these patients.
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Akiyama Y, Koyanagi I, Mikuni N. Chronic Spinal Subdural Hematoma Associated with Antiplatelet Therapy. World Neurosurg 2017; 105:1032.e1-1032.e5. [DOI: 10.1016/j.wneu.2016.11.128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 11/23/2016] [Accepted: 11/24/2016] [Indexed: 10/20/2022]
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12
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Subarachnoid Hemorrhage and Spinal Subdural Hematoma Due to Acute CSF Hypotension. Neurocrit Care 2016; 26:109-114. [DOI: 10.1007/s12028-016-0327-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Concomitant Intracranial Chronic Subdural Hematoma and Spinal Subdural Hematoma: A Case Report and Literature Review. World Neurosurg 2016; 90:706.e1-706.e9. [DOI: 10.1016/j.wneu.2016.03.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 03/08/2016] [Accepted: 03/08/2016] [Indexed: 11/19/2022]
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Kanamaru H, Kanamaru K, Araki T, Hamada K. Simultaneous Spinal and Intracranial Chronic Subdural Hematoma Cured by Craniotomy and Laminectomy: A Video Case Report. Case Rep Neurol 2016; 8:72-7. [PMID: 27194987 PMCID: PMC4868945 DOI: 10.1159/000445709] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Simultaneous spinal and intracranial chronic subdural hematoma (CSDH) is a rare entity. A 67-year-old man visited our hospital due to headache after diving into a river 2 weeks before. Non-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) revealed bilateral intracranial CSDH. The bilateral CSDH was evacuated and his symptoms improved. Three days after craniotomy, he complained of sensory disturbance on his buttocks. Lumbar MRI showed a space-occupying lesion behind the thecal sac at L5. CT with myelography showed a subdural mass lesion; there was no communication with the subarachnoid space. Fourteen days after craniotomy, L5 laminectomy was performed and the dura mater was incised carefully. The video shows that a liquid hematoma similar to the intracranial CSDH flowed out, followed by cerebrospinal fluid. His symptoms improved after the operation and the hematoma did not recur. This is a rare condition of spinal CSDH demonstrated by neuroimaging and intraoperative video.
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15
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Mattei TA, Rehman AA, Dinh DH. Acute Spinal Subdural Hematoma after Vertebroplasty: A Case Report Emphasizing the Possible Etiologic Role of Venous Congestion. Global Spine J 2015; 5:e52-8. [PMID: 26430602 PMCID: PMC4577316 DOI: 10.1055/s-0035-1544155] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 12/08/2014] [Indexed: 12/28/2022] Open
Abstract
Study Design Case report and literature review. Objective Spinal subdural hematomas are rare events that often progress with severe neurologic deficits. Although there have been several case reports in the literature of spontaneous spinal subdural hematomas in the setting of anticoagulation, antiplatelet therapy, or coagulation disorders, the exact pathophysiology of such phenomena remains obscure. Methods We present the first report of a subdural hematoma after a percutaneous vertebroplasty and provide a comprehensive review on the anatomy of venous drainage of the vertebral bodies with emphasis on the possible effects of venous congestion caused by cement obstruction. Results Because the subdural hematoma occurred in the absence of major cement extravasation to the spinal canal and two levels above the site of the vertebroplasty, we discuss the possible role of venous congestion as the main etiologic factor leading to rupture of the fragile, valveless radiculomedullary veins into the subdural space. Conclusions The reported case supports a possible new pathophysiological scheme for the development of spinal subdural hematoma in which venous congestion plays a pivotal etiologic role. The reported findings suggests that future anatomical and histologic studies investigating the response of the radiculomedullary veins to congestive venous hypertension may shed new light into the pathophysiology of spinal subdural hematomas.
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Affiliation(s)
- Tobias A. Mattei
- Department of Neurosurgery, Brain and Spine Institute, Buffalo, New York, United States,Address for correspondence Tobias A. Mattei, MD Brain and Spine Institute400 International Drive, Buffalo, NY 14221United States
| | - Azeem A. Rehman
- Department of Medicine, University of Illinois College of Medicine at Peoria, Peoria, Illinois, United States
| | - Dzung H. Dinh
- Department of Neurosurgery, University of Illinois College of Medicine at Peoria, Peoria, Illinois, United States
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16
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Nontraumatic spinal subdural hematoma complicating direct factor Xa inhibitor treatment (rivaroxaban): a challenging management. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25 Suppl 1:100-3. [DOI: 10.1007/s00586-015-4160-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 07/23/2015] [Indexed: 10/23/2022]
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17
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Visocchi M, La Rocca G, Signorelli F, Roselli R, Jun Z, Spallone A. 10 Levels thoracic no-intrumented laminectomy for huge spontaneous spinal subdural hematoma removal. Report of the first case and literature review. Int J Surg Case Rep 2015; 15:57-62. [PMID: 26318128 PMCID: PMC4601942 DOI: 10.1016/j.ijscr.2015.06.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/04/2015] [Accepted: 06/27/2015] [Indexed: 11/04/2022] Open
Abstract
In this article, reporting on the case of a huge 10 levels spontaneous spinal subdural hematoma treated with decompressive thoracic no-instrumented laminectomy in a 45-year-old woman with good neurological recovery, we would like to underline the importance of a timely surgical decompression as the mainstay option in the management of strongly symptomatic spontaneous idiopathic acute spinal subdural hematomas. To our knowledge, 10 levels thoracic laminectomy for a SSDH removal have never been described. We performed “conservative” laminectomy by sparing of articular processes with no need to posterior fixation also considering the intrinsic stability of thoracic chest.
Introduction Spontaneous idiopathic acute spinal subdural hematoma (SSDH) is a rare cause of acute back pain followed by signs and symptoms of nerve root and/or spinal cord compression, frequently associated with coagulopathies, blood dyscrasias and arterio-venous malformations. Standard management includes non-operative treatment and timely (within 24 h) surgical decompression. Presentation of case We report on the case of a huge 10 levels SSDH treated with decompressive thoracic no-instrumented laminectomy in a 45-year-old woman with good neurological recovery (from ASIA A to D). Discussion Spontaneous SSDHs without detectable structural lesion or anticoagulant therapy are very rare. Among 26 cases documented the literature harbouring SSDHs, the thoracic spine was found to be the preferred site, and the compression was usually extending over several vertebral levels. Nonoperative treatment for SSDH may be justified in presence of minimal neurologic deficits, otherwise, early decompressive laminectomy along with evacuation of hematoma are considered the treatment of choice in presence of major deficits. Conclusion To our knowledge, the present case is the most extensive laminectomy for a SSDH removal never described before. No postoperative instability occurs in 10 levels thoracic laminectomy in case the articular processes are spared. When major neurological deficits are documented, early decompressive laminectomy with evacuation of hematoma should be considered the best treatment for SSDH.
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Affiliation(s)
| | - Giuseppe La Rocca
- Institute of Neurosurgery, Catholic University School of Medicine of Rome, Italy
| | - Francesco Signorelli
- Institute of Neurosurgery, Catholic University School of Medicine of Rome, Italy.
| | - Romeo Roselli
- Institute of Neurosurgery, Catholic University School of Medicine of Rome, Italy
| | - Zhong Jun
- Department of Neurosurgery, Xin Hua Hospital, Shanghai University, China
| | - A Spallone
- Neurosurgical Unit, Department of Neurosciences, Neurological Centre of Latium, Rome, Italy
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18
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Zhu YJ, Peng DQ, Shen F, Wang LL, Tang ZX, Zhang JM. Spontaneous thoracic ventral spinal subdural hematoma mimicking a tumoral lesion: a case report. J Med Case Rep 2015; 9:132. [PMID: 26048171 PMCID: PMC4470086 DOI: 10.1186/s13256-015-0562-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 03/03/2015] [Indexed: 11/12/2022] Open
Abstract
Introduction Spinal subdural hematoma is rare and can cause serious neurological symptoms. Sometimes, idiopathic spinal subdural hematoma can spontaneously occur without any identifiable underlying etiologies. In this report, we present such an uncommon case of paraplegia caused by idiopathic spinal subdural hematoma that was successfully managed by laminectomy. Case presentation A 45-year-old Chinese woman presented with sudden onset of progressive asthenia and numbness in both lower extremities, accompanied by difficulty in micturition. An initial non-contrast spinal magnetic resonance imaging at a local hospital suggested a spinal subdural tumoral hematoma at the T9 level. She was referred to our hospital and an emergency laminectomy from T8 to T10 was performed 22 hours after onset of her initial symptoms. However, nothing but a hematoma was identified during the operation, and a final diagnosis of spontaneous acute spinal subdural hematoma was concluded. She had partial return of sensations and voluntary movement after the operation. Conclusions On imaging findings, spinal subdural hematoma could manifest as focal and independent from the dura matter, and, therefore, it should be included in the differential diagnosis of medullary compressive lesions.
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Affiliation(s)
- Yong-Jian Zhu
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.
| | - De-Qing Peng
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.
| | - Fang Shen
- Department of Neurosurgery, Ningbo No.2 Hospital, Ningbo, Zhejiang, 315010, China.
| | - Lin-Lin Wang
- Department of Physiology, Zhejiang University School of Medicine, Hangzhou, 310009, China.
| | - Zhu-Xiao Tang
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.
| | - Jian-Min Zhang
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.
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Kokubo R, Kim K, Mishina M, Isu T, Kobayashi S, Yoshida D, Morita A. Prospective assessment of concomitant lumbar and chronic subdural hematoma: is migration from the intracranial space involved in their manifestation? J Neurosurg Spine 2014; 20:157-63. [DOI: 10.3171/2013.10.spine13346] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Spinal subdural hematomas (SDHs) are rare and some are concomitant with intracranial SDH. Their pathogenesis and etiology remain to be elucidated although their migration from the intracranial space has been suggested. The authors postulated that if migration plays a major role, patients with intracranial SDH may harbor asymptomatic lumbar SDH. The authors performed a prospective study on the incidence of spinal SDH in patients with intracranial SDH to determine whether migration is a key factor in their concomitance.
Methods
The authors evaluated lumbar MR images obtained in 168 patients (125 males, 43 females, mean age 75.6 years) with intracranial chronic SDH to identify cases of concomitant lumbar SDH. In all cases, the lumbar MRI studies were performed within the 1st week after surgical irrigation of the intracranial SDH.
Results
Of the 168 patients, 2 (1.2%) harbored a concomitant lumbar SDH; both had a history of trauma to both the head and the hip and/or lumbar area. One was an 83-year-old man with prostate cancer and myelodysplastic syndrome who suffered trauma to his head and lumbar area in a fall from his bed. The other was a 70-year-old man who had hit his head and lumbar area in a fall. Neither patient manifested neurological deficits and their hematomas disappeared under observation. None of the patients with concomitant lumbar SDH had sustained head trauma only, indicating that trauma to the hip or lumbar region is significantly related to the concomitance of SDH (p < 0.05).
Conclusions
As the incidence of concomitant lumbar and intracranial chronic SDH is rare and both patients in this study had sustained a direct impact to the head and hips, the authors suggest that the major mechanism underlying their concomitant SDH was double trauma. Another possible explanation is hemorrhagic diathesis and low CSF syndrome.
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Affiliation(s)
- Rinko Kokubo
- 1Department of Neurosurgery, Nippon Medical School Chiba Hokuso Hospital, Chiba
| | - Kyongsong Kim
- 1Department of Neurosurgery, Nippon Medical School Chiba Hokuso Hospital, Chiba
| | - Masahiro Mishina
- 2Department of Neurological Science, Graduate School of Medicine, and
| | - Toyohiko Isu
- 3Department of Neurosurgery, Kushiro Rosai Hospital, Hokkaido, Japan
| | - Shiro Kobayashi
- 1Department of Neurosurgery, Nippon Medical School Chiba Hokuso Hospital, Chiba
| | - Daizo Yoshida
- 4Department of Neurosurgery, Nippon Medical School, Tokyo; and
| | - Akio Morita
- 4Department of Neurosurgery, Nippon Medical School, Tokyo; and
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21
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Acute Nontraumatic Spinal Intradural Hematoma in a Patient on Warfarin. J Emerg Med 2013; 45:695-7. [DOI: 10.1016/j.jemermed.2013.04.048] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Revised: 04/15/2013] [Accepted: 04/30/2013] [Indexed: 11/18/2022]
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22
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Acute spinal subdural hematoma with hemiplegia after acupuncture: a case report and review of the literature. Spine J 2013; 13:e59-63. [PMID: 24094991 DOI: 10.1016/j.spinee.2013.06.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 03/13/2013] [Accepted: 06/01/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Subdural spinal hematoma (SDH) is a very rare entity; however, it can lead to serious complications resulting from injuries to the spinal cord and roots. Although acupuncture has been a popular method for the management of pain control, we encountered the first case of SDH after acupuncture. PURPOSE The purpose of this case report was to present the first case of subdural hematoma after acupuncture and the reasons for the risks of blind cervical acupuncture. STUDY DESIGN A case report and review of the previous literature are presented. METHODS A 69-year-old man complained of progressive weakness in the right upper and lower extremities 2 hours after acupuncture on the cervical spine and back. The diagnosis was delayed because of unilateral weakness, and the symptom was initially misinterpreted as a transient ischemic attack because of no sensory change and pain and normal findings of two brain magnetic resonance imaging (MRI). RESULTS Cervical MRI 36 hours after onset revealed acute hematoma from the C3-C5 level; hematoma showed an isointensity on T1-weighted image (WI) with the preservation of epidural fat and a hypointensity on T2WI. A decompressive surgery was scheduled to perform within 2 days after the cervical MRI scan because of a previous anticoagulation therapy, but the patient refused it. Finally, 9 days after the onset, surgical decompression and removal of hematoma were performed. Three months postoperatively, the patient had fully recovered demonstrating fine hand movement and good ability to walk up and down the stairs. CONCLUSIONS Our study indicates that it is essential to perform cervical MRI when a patient does not show an improvement in the neurologic deficit and has a negative brain MRI after acupuncture. In addition, blind acupuncture if not correctly practiced may be harmful to the cervical structures.
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Kamo M, Watanabe Y, Numaguchi Y, Saida Y. Spinal subdural hematoma mimicking epidural lipomatosis. Magn Reson Med Sci 2012; 11:197-9. [PMID: 23037565 DOI: 10.2463/mrms.11.197] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We report a case of spinal subdural hematoma in the lumbar spine of a 75-year-old woman. Magnetic resonance imaging showed lesions of homogeneous high intensity in the spinal canal on both T₁- and T₂-weighted images, findings closely resembling those for epidural lipomatosis. Identification of 2-layered signal intensity surrounding the cauda equina on axial images is the key for accurate diagnosis.
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Affiliation(s)
- Minobu Kamo
- Department of Radiology, St. Luke's International Hospital, Chuo-ku Tokyo, Japan.
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24
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WAJIMA D, YOKOTA H, IDA Y, NAKASE H. Spinal Subdural Hematoma Associated With Traumatic Intracranial Interhemispheric Subdural Hematoma. Neurol Med Chir (Tokyo) 2012; 52:636-9. [DOI: 10.2176/nmc.52.636] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Yuki IDA
- Department of Neurosurgery, Nabari City Hospital
| | - Hiroyuki NAKASE
- Department of Neurosurgery, Nara Medical University School of Medicine
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25
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Yang NR, Kim SJ, Cho YJ, Cho DS. Spontaneous resolution of nontraumatic acute spinal subdural hematoma. J Korean Neurosurg Soc 2011; 50:268-70. [PMID: 22102963 DOI: 10.3340/jkns.2011.50.3.268] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 07/07/2011] [Accepted: 09/05/2011] [Indexed: 11/27/2022] Open
Abstract
Spinal subdural hematoma (SSDH) is an extremely uncommon condition. Causative factors include trauma, anticoagulant drug administration, hemostatic disorders, and vascular disorders such as arteriovenous malformations and lumbar punctures. Of SSDH cases, those that do not have any traumatic event can be considered cases of nontraumatic acute spinal subdural hematoma, which is known to have diverse clinical progress. Treatment typically consists of surgical decompression and cases in which the condition is relieved with conservative treatment are rarely reported. We report two nontraumatic acute spinal subdural hematoma patients who were successfully treated without surgery.
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Affiliation(s)
- Na-Rae Yang
- Department of Neurosurgery, Ewha Womans University School of Medicine, Mokdong Hospital, Seoul, Korea
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26
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Berhouma M, Al Dahak N, Messerer R, Al Rammah M, Vallee B. A rare, high cervical traumatic spinal subdural hematoma. J Clin Neurosci 2011; 18:569-74. [PMID: 21277780 DOI: 10.1016/j.jocn.2010.07.127] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 07/14/2010] [Accepted: 07/17/2010] [Indexed: 11/30/2022]
Abstract
Spinal subdural hematomas (SSDH) are rare lesions occurring in association with a wide variety of conditions, including anticoagulation, coagulation disorders, spinal anesthesia, lumbar puncture, spinal tumors and vascular malformations. SSDH resulting from trauma are the exception. We present a 62-year-old woman with a rare post-traumatic focal SSDH at C1 with bulbomedullary compression, treated successfully with surgery. A review of the literature revealed 26 patients with traumatic SSDH. The aim of this report is to describe the clinical presentation, imaging characteristics and management of traumatic SSDH. The controversial pathogenesis is also discussed.
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Affiliation(s)
- Moncef Berhouma
- Department of Neurosurgery B (Unit 501), Pierre Wertheimer Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel 69394, Lyon Cedex 03, France.
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27
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Payer M, Agosti R. Spontaneous acute spinal subdural hematoma: spontaneous recovery from severe paraparesis--case report and review. Acta Neurochir (Wien) 2010; 152:1981-4. [PMID: 20700748 DOI: 10.1007/s00701-010-0758-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 07/23/2010] [Indexed: 12/25/2022]
Abstract
Spontaneous idiopathic acute spinal subdural hematomas are highly exceptional. Neurological symptoms are usually severe, and rapid diagnosis with MRI is mandatory. Surgical evacuation has frequently been used therapeutically; however, spontaneous recovery in mild cases has also been reported. We present a case of spontaneous recovery from severe paraparesis after spontaneous acute SSDH, and review the English-speaking literature.
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Affiliation(s)
- Michael Payer
- Neurosurgery Klinik Hirslanden, Witellikerstrasse 40, 8032, Zürich, Switzerland.
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28
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Nagashima H, Tanida A, Hayashi I, Tanishima S, Nanjo Y, Dokai T, Teshima R. Spinal subdural haematoma concurrent with cranial subdural haematoma: Report of two cases and review of literature. Br J Neurosurg 2010; 24:537-41. [DOI: 10.3109/02688691003656119] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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29
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Varela Rois P, González García J, Regueira Portas M, Martínez Cueto P, Azevedo González E. Spinal haematomas: The spinal aplopexy. NEUROLOGÍA (ENGLISH EDITION) 2010. [DOI: 10.1016/s2173-5808(10)70019-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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30
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Varela Rois P, González García J, Regueira Portas M, Martínez Cueto P, Azevedo González E. Hematomas espinales: la apoplejía espinal. Neurologia 2010; 25:96-103. [DOI: 10.1016/s0213-4853(10)70033-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Cincu R, de Asis Lorente F, Rivero D, Eiras J, Ara JR. Spontaneous subdural hematoma of the thoracolumbar region with massive recurrent bleed. Indian J Orthop 2009; 43:412-5. [PMID: 19838395 PMCID: PMC2762564 DOI: 10.4103/0019-5413.49383] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Spinal subdural hematoma is a rare disorder and can be caused by abnormalities of coagulation, blood dyscrasias, lumbar puncture, trauma, underlying neoplasm, and arteriovenous malformation. We discuss an unusual case of an elderly woman who presented with spontaneous spinal subdural hematoma and developed massive rebleeding on the third day following initial evacuation of hematoma. This case illustrates that a patient with routine normal coagulation profile and adequate hemostasis can still harbor platelet dysfunction (in present case due to polycythemia) and later on can manifest as rebleeding and neurological deterioration.
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Affiliation(s)
- Rafael Cincu
- Department of Neurosurgery, Miguel Servet University Hospital, Zaragoza, Spain,Address for correspondence: Dr. Rafael Cincu, Department of Neurosurgery, Miguel Servet University Hospital, Zaragoza, Spain. E-mail:
| | | | - David Rivero
- Department of Neurosurgery, Miguel Servet University Hospital, Zaragoza, Spain
| | - José Eiras
- Department of Neurosurgery, Miguel Servet University Hospital, Zaragoza, Spain
| | - José Ramón Ara
- Department of Neurology, Miguel Servet University Hospital, Zaragoza, Spain
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32
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Kim SD, Park JO, Kim SH, Lee YH, Lim DJ, Park JY. Spontaneous thoracic spinal subdural hematoma associated with fibromuscular dysplasia. J Neurosurg Spine 2008; 8:478-81. [PMID: 18447696 DOI: 10.3171/spi/2008/8/5/478] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Spontaneous spinal subdural hematoma (SDH) is an uncommon cause of acute spinal cord compression. When it does occur, however, it may have disastrous results and a poor prognosis. The nontraumatic acute spinal SDH usually results from a defect in a hemostatic mechanism (such as coagulopathy or the use of anticoagulant therapy) or from iatrogenic causes (such as spinal puncture). Fibromuscular dysplasia (FMD) is a nonatherosclerotic systemic arteriopathy of unknown cause that typically affects the small and medium arteries in young to middle-aged women. The authors report on their experience with a patient with an acute spontaneous spinal SDH that occurred in conjunction with FMD.
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Affiliation(s)
- Sang-Dae Kim
- Department of Neurosurgery, Korea University Ansan Hospital, Ansan, Korea
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33
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Park DH, Cho TH, Lee JB, Park JY, Park YK, Chung YG, Suh JK. Rapid spontaneous remission of a spontaneous spinal chronic subdural hematoma in a child. Neurol Med Chir (Tokyo) 2008; 48:231-4. [PMID: 18497499 DOI: 10.2176/nmc.48.231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 13-year-old boy presented with a rare spontaneous spinal chronic subdural hematoma (SCSDH) with no associated trauma or medical problems manifesting as back and bilateral lower extremity pain persisting for 10 days. Neurological examination revealed mild weakness and paresthesia in both lower extremities. Magnetic resonance (MR) imaging performed 1 week after the appearance of symptoms revealed a chronic subdural hematoma at the thoracolumbosacral region. Follow-up MR imaging performed 1 week later showed significant resolution of the hematoma without the need for surgery. The patient was discharged with only conservative management. This case of spontaneous SCSDH with rapid spontaneous remission in a child not associated with coagulopathy indicates that aggressive surgical treatment should be delayed as long as possible in pediatric patients because the spinal structure is still developing.
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Affiliation(s)
- Dong-Hyuk Park
- Department of Neurosurgery, Korea University, College of Medicine, Seoul, ROK
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35
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Braun P, Kazmi K, Nogués-Meléndez P, Mas-Estellés F, Aparici-Robles F. MRI findings in spinal subdural and epidural hematomas. Eur J Radiol 2007; 64:119-25. [PMID: 17353109 DOI: 10.1016/j.ejrad.2007.02.014] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Revised: 02/06/2007] [Accepted: 02/13/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Spinal hematomas are rare entities that can be the cause of an acute spinal cord compression syndrome. Therefore, an early diagnosis is of great importance. PATIENTS AND METHODS From 2001 to 2005 seven patients with intense back pain and/or acute progressive neurological deficit were studied via 1.5 T MRI (in axial and sagittal T1- and T2-weighted sequences). Follow-up MRI was obtained in six patients. RESULTS Four patients showed the MRI features of a hyperacute spinal hematoma (two spinal subdural hematoma [SSH] and two spinal epidural hematoma [SEH]), isointense to the spinal cord on T1- and hyperintense on T2-weighted sequences. One patient had an early subacute SEH manifest as heterogeneous signal intensity with areas of high signal intensity on T1- and T2-weighted images. Another patient had a late subacute SSH with high signal intensity on T1- and T2-weighted sequences. The final patient had a SEH in the late chronic phase being hypointense on T1- and T2-weighted sequences. DISCUSSION MRI is valuable in diagnosing the presence, location and extent of spinal hematomas. Hyperacute spinal hematoma and the differentiation between SSH and SEH are particular diagnostic challenges. In addition, MRI is an important tool in the follow-up in patients with conservative treatment.
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Affiliation(s)
- Petra Braun
- Department of Radiology, Hospital La Plana, Ctra. De Vila-real a Borriana km. 0,5, 12540 Vila-real, Castelló, Spain.
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36
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N'dri Oka D, Aesch B, Jan M. [Acute non-traumatic extensive subdural spinal hematoma]. Neurochirurgie 2007; 53:292-5. [PMID: 17602712 DOI: 10.1016/j.neuchi.2007.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2006] [Accepted: 03/26/2007] [Indexed: 10/19/2022]
Abstract
Acute spinal subdural hematoma is a somewhat rare pathology. Its severity comes from the constitution of an acute spinal cord compression. In many cases MRI is useful for the differential diagnosis with the epidural hematoma. A 79-year-old patient was referred for emergency neurosurgery for acute spinal cord compression. The vascular risk in this patient was significant: hypertension, oral anticoagulants. Clinically, acute non-traumatic subdural spinal hematoma was suspected. The spinal cord MRI was in favor of the diagnosis which was confirmed intraoperatively. The surgical procedure revealed an extensive hematoma which infiltrated the spinal cord. The diagnosis of nontraumatic subdural spinal hematoma may be difficult in some cases and correctly established only during the surgical procedure. In comparison with reports in the literature, we discuss the underlying mechanisms of this hematoma. Spinal subdural haematoma must be considered in patients taking anticoagulant therapy or with a coagulation disorder who present signs of acute spinal cord compression. MRI sagittal T1 and T2-weighted images are adequate and reliable for diagnosis of spinal subdural hematoma. Prompt surgical evacuation of this hematoma is crucial.
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Affiliation(s)
- D N'dri Oka
- Service de neurochirurgie, hôpital Bretonneau, 2 bis, boulevard Tonnellé, 37044 Tours cedex, France.
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37
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Braun P, Nogués-Meléndez P, Montoliu Fornás G, Martínez Martínez JC, Marcos Naranjo E. [Spontaneous spinal subdural hematoma: MRI findings in two cases]. RADIOLOGIA 2007; 49:47-50. [PMID: 17397622 DOI: 10.1016/s0033-8338(07)73716-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Spontaneous spinal subdural hematoma is an uncommon finding. This report of two cases of spinal subdural hematoma (one hyperacute and one subacute) discusses the current theory of how it develops, the MRI findings, its differentiation from spinal epidural hematoma, and the value of MRI in monitoring patients undergoing conservative treatment. The most significant MRI findings in the hyperacute phase were isointense signal on T1-weighted sequences and hyperintense signal on T2-weighted sequences. Moreover, T2-weighted gradient-echo sequences showed a hypointense peripheral ring. In the subacute phase, a hyperintense signal was seen on T1-, T1-fat-suppression, and T2-weighted sequences.
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Affiliation(s)
- P Braun
- Departamento de Radiodiagnóstico, Hospital La Fe, Valencia, España.
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38
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Mashiko R, Noguchi S, Uemura K, Takada T, Matsumura A. Lumbosacral subdural hematoma. Case report. Neurol Med Chir (Tokyo) 2006; 46:258-61. [PMID: 16723821 DOI: 10.2176/nmc.46.258] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
An 18-year-old man presented with a rare spinal subdural hematoma (SSH) manifesting as headache, which developed following diving into the sea the day before. Computed tomography of the head revealed no abnormality. His headache persisted followed by neck stiffness and mild lumbago. He came to see us 6 days after the first visit. He underwent lumbar puncture to eliminate the possibility of meningitis. The cerebrospinal fluid showed xanthochromia. Cerebral angiography showed no abnormality. Magnetic resonance imaging of the spine revealed lumbosacral subdural hematoma. The hematoma and his symptoms regressed spontaneously during several weeks of conservative treatment. A sharp increase in intraabdominal and/or intrathoracic pressures following diving may have caused the bleeding. Headache may be an initial symptom associated with subarachnoid hemorrhage concomitant with SSH. Delayed progression of lumbosacral SSH must be considered if the patient complains of lumbago following minor trauma.
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Affiliation(s)
- Ryota Mashiko
- Department of Neurosurgery, Kitaibaraki Municipal General Hospital, Ibaraki, Japan.
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Aydin MV, Sen O, Tufan K, Caner H. Atypical traumatic craniocervical junction focal spinal subdural hematoma. Pediatr Neurosurg 2006; 42:197-9. [PMID: 16636626 DOI: 10.1159/000091868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Spinal subdural hematoma (SSDH) is a rare entity and post-traumatic cervical SSDH is very rare. Review of the literature revealed 8 reported cases of traumatic SSDH and only 2 were cervical. The exact mechanism and pathogenesis of SSDHs are unclear. There are still controversies about the source of bleeding and mechanisms of formation of a hematoma. Here we report a case of a unique traumatic craniocervical junction focal subdural hematoma in an 8-year-old boy and discuss the possible mechanisms of SSDHs in trauma cases.
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Affiliation(s)
- M Volkan Aydin
- Department of Neurosurgery, Medical Faculty, Baskent University, Adana, Turkey.
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40
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Eftekhar B, Ghodsi M, Ketabchi E, Bakhtiari A, Mostajabi P. Spinal subdural hematoma revealing hemophilia A in a child: A case report. BMC BLOOD DISORDERS 2003; 3:2. [PMID: 12904268 PMCID: PMC194670 DOI: 10.1186/1471-2326-3-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2003] [Accepted: 08/07/2003] [Indexed: 11/17/2022]
Abstract
BACKGROUND: Intraspinal bleeding especially in the form of subdural hematoma is rare in hemophiliacs. In the present case, we report a neglected hemophilic A child with such a problem and discuss its management options. CASE PRESENTATION: A 9-year old hemophilic A boy presented with quadriparesis, confusion and meningismus after a fall 4 days previously. There was no sign of direct trauma to his back. His CT Scan and MRI showed spinal extramedullary hematoma extended from C5 to L2. We corrected the factor VIII level, but two days later, the patient's lower limbs weakened to 1/5 proximally as well as distally. We performed a laminectomy from T11 to L2, according to the level of the maximal neurological deficit and recent deterioration course. The subdural hematoma was evacuated. The hematoma in other spinal levels was managed conservatively. In the week following the operation, the patient's neurological status approached normal. CONCLUSION: This case calls attention to the clinical manifestation, radiological features and management options of the rarely reported intraspinal hematoma in hemophilic children. Although this case has been managed operatively for its hematoma in the thoracolumbar region, at the same time it can be considered a successful case of conservative management of intraspinal hematoma in the cervicothoracic region. Both conservative and surgical management could be an option in managing these patients considering their neurological course.
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Affiliation(s)
- Behzad Eftekhar
- Department of Neurosurgery, Sina Hospital, Tehran University, Iran
| | - Mohammad Ghodsi
- Department of Neurosurgery, Sina Hospital, Tehran University, Iran
| | - Ebrahim Ketabchi
- Department of Neurosurgery, Sina Hospital, Tehran University, Iran
| | - Abbas Bakhtiari
- Department of Neurosurgery, Sina Hospital, Tehran University, Iran
| | - Pardis Mostajabi
- Department of Neurosurgery, Sina Hospital, Tehran University, Iran
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41
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Lecouvet FE, Annet L, Duprez TP, Cosnard G, Scordidis V, Malghem J. Uncommon magnetic resonance imaging observation of lumbar subdural hematoma with cranial origin. J Comput Assist Tomogr 2003; 27:530-3. [PMID: 12886137 DOI: 10.1097/00004728-200307000-00013] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A patient with a history of pain, paresthesias, and weakness in both legs is reported. Magnetic resonance imaging (MRI) of the lumbar spine demonstrated subacute subdural hematoma. Brain MRI obtained 1 day later because of progressive headache showed hemorrhagic cortical metastasis and extensive subdural hematoma. It is hypothesized that the lumbar hematoma originated from the intracranial bleeding, which was substantiated by the observation of a thin hemorrhagic collection connecting cranial and lumbar hematomas on MRI. Cranial origin should be included in the differential diagnosis of spontaneous spinal subdural hematomas.
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Affiliation(s)
- Frédéric E Lecouvet
- Department of Medical Imaging, Saint Luc University Hospital, Université Catholique de Louvain, Hippocrate Avenue 10/2942B, 1200 Brussels, Belgium.
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