Spinal subarachnoid hematoma of unknown etiology. A case report

Aneurysmal subarachnoid hemorrhage complicating spinal subarachnoid hematoma causing acute cauda equina syndrome: a case report

BACKGROUND

Spinal subarachnoid hematoma (SSH) is a known but rare entity that can cause cauda equina compression. The occurrence of SSH associated with aneurysmal subarachnoid hemorrhage has rarely been described in the literature.

CASE PRESENTATION

A 56-year-old woman presented with subarachnoid hemorrhage secondary to a ruptured middle cerebral artery aneurysm and was managed with coiling embolization without stent assistance. There was no history of either lumbar puncture or the use of anticoagulants. The patient developed severe lumbago radiating to bilateral legs nine days after the procedure. Subsequent magnetic resonance imaging demonstrated a SSH extending from L5 to S2 and wrapping around the cauda equina. The patient was treated with intravenous methylprednisolone (250 mg/day) for four consecutive days, followed by a taper of oral prednisolone (20 mg/day) until complete recovery. Magnetic resonance imaging at one month follow-up revealed complete resolution of the SSH.

CONCLUSIONS

Here, we report a case of acute cauda equina syndrome caused by a SSH after aneurysmal subarachnoid hemorrhage, which will facilitate timely intervention of patients with this disorder.

Acute non-traumatic spinal subarachnoid hematomas: A report of five cases and a systematic review of literature

BACKGROUND

There is a lack of evidence on spinal subarachnoid hematomas because of the rarity of their spontaneous development and difficulty in diagnosis. The aim of this study was to identify the characteristics and outcomes of surgically confirmed acute non-traumatic spinal subarachnoid hematomas from a multicenter surgical database and conduct a systematic review of existing literature.

METHODS

Five surgically confirmed cases of acute non-traumatic spinal subarachnoid hematomas were identified from our multicenter database with 22 cases from a systematic review of existing literature.

RESULTS

The mean age of the 27 patients was 59 years. The length of the hematoma was longer than five vertebrae in 70% of the patients, most commonly distributed in the thoracic spine; 63% of all cases were idiopathic, 30% were under anticoagulant therapy, and the remaining 7% presented with coagulation abnormalities. As many as 70% of the patients showed some improvement in neurological symptoms after surgery during a mean follow-up period of 14 months.

CONCLUSIONS

This study elucidated the characteristics of acute non-traumatic spinal subarachnoid hematomas in patients who were surgically confirmed. Most patients were middle-aged, complained of back pain, and had the hematoma located in the thoracic spine. Seventy percent of the patients in this study had some improvement in their neurological status, most likely due to surgical decompression and hematoma evacuation.

Spinal Subarachnoid Hematoma After Cardiac Angiography in an Infant: A Case Report

Spinal subarachnoid hematoma may result in sequelae such as bilateral lower extremity paralysis and vesicorectal disturbances. Although spinal subarachnoid hematoma is rare in infants, early intervention has been suggested to improve neurological prognosis. Therefore, clinicians are encouraged to make early diagnosis and surgical intervention. A 22-month-old boy was prescribed aspirin for a congenital heart disease. A routine cardiac angiography was performed under general anesthesia. Fever and oliguria developed on the next day, followed by flaccid paralysis of the lower limbs four days later. Five days later, he was diagnosed with spinal subarachnoid hematoma and associated spinal cord shock. Even after emergent posterior spinal decompression, hematoma removal, and rehabilitation, the patient remained with bladder rectal disturbance and flaccid paralysis of both lower limbs. Diagnosis and treatment of this case were delayed mainly because of his difficulty to complain of back pain and paralysis. The neurogenic bladder was one of the first neurological symptoms in our case, so it may be important to consider spinal cord involvement in infants with bladder compromise. Risk factors for spinal subarachnoid hematoma in infants are largely unknown. The patient had undergone a cardiac angiography the day before the onset of the symptoms, which may be related to subarachnoid hematoma. However, similar reports are scarce, with only one case of spinal subarachnoid hematoma reported in an adult following cardiac catheter ablation. Accumulation of evidence regarding risk factors for subarachnoid hematoma in infants is warranted.

Spontaneous spinal subarachnoid hemorrhage after severe coughing: a case report

Introduction

Spinal subarachnoid hemorrhage has many causes including trauma, vascular malformations, aneurysms, spinal cord tumors, coagulation abnormalities, use of anticoagulants, systemic lupus erythematosus, or Behçet’s disease. We report on a rare case of a spontaneous spinal subarachnoid hemorrhage after severe coughing of unknown origin. To the best of our knowledge, this is the first report of spontaneous spinal subarachnoid hemorrhage after severe coughing.

Case presentation

A 66-year-old Japanese woman initially complained of headache with severe back pain after severe coughing. She was referred to our neurology department 6 days after her first visit to our hospital. No neurological deficits were revealed except for meningism. Computed tomography of her head revealed no abnormality. A lumbar puncture showed bloody cerebrospinal fluid with xanthochromia. Cerebral angiography revealed no abnormality. Magnetic resonance imaging of her lumbar spine revealed subarachnoid hemorrhage. Spinal angiography revealed no abnormality. The diagnosis of spontaneous spinal subarachnoid hemorrhage was made. She recovered with conservative treatment and her neurological status was normal 2 years after the onset.

Conclusions

Spontaneous spinal subarachnoid hemorrhage could be caused by rapid changes in intrathoracic and intra-abdominal pressure. Spontaneous subarachnoid hemorrhage should be considered when sudden back pain associated with severe headache develops. Even though emergent surgical decompression is necessary when the neurological state progressively deteriorates, conservative treatment with close monitoring of the symptoms can be recommended for patients with a stable neurological status.