Concomitant Intracranial and Lumbar Chronic Subdural Hematoma Treated by Fluoroscopic Guided Lumbar Puncture: A Case Report and Literature Review

Surgical management of spinal intradural hematomas: illustrative cases

BACKGROUND

Spinal intradural hematoma (SIH) is a rare condition with potential for permanent neurological deficit. SIH can be managed conservatively with serial imaging or surgically with lumbar drainage or open evacuation. We present 3 SIH cases managed with multiple surgical techniques, including a novel lumbar drainage-and-advancement technique, and review the literature.

OBSERVATIONS

Patient 1 was a 35-year-old peripartum female with cauda equina syndrome after epidural analgesia. MRI revealed SIH at L4-5, necessitating urgent L3-S1 laminectomy and hematoma evacuation. Patient 2 was a 47-year-old male with bilateral lower extremity radiculopathy following posterior decompression and fusion for an L5 compression fracture. MRI revealed SIH extending from T3-L5. Focal decompression and lumbar drain placement with cranial advancement were performed for complete evacuation. Patient 3 was a 75-year-old male with urinary retention after restarting anticoagulation 4 days postlaminectomy for resection of a large synovial cyst at L4-5. MRI demonstrated a subdural collection suggestive of hygroma. A focal laminectomy with intrathecal decompression and a lumbar drain were used to completely evacuate the lesion.

LESSONS

SIH management should be individualized. Focal decompression is effective for localized hematomas, while extensive, multilevel SIH may benefit from a lumbar drain with controlled cranial advancement, irrigation, and decompression. https://thejns.org/doi/10.3171/CASE25108.

Spinal Chronic Subdural Hematoma Cured by Lumbar Drainage: A Case Report and Literature Review

Chronic spinal subdural hematoma is an extremely rare condition. We recently encountered a case of symptomatic thoracolumbar chronic spinal subdural hematoma in an older patient caused by a fall. The patient was a man in his 80s with a history of cerebral infarction, who was receiving oral antiplatelet therapy. He was hospitalized for conservative treatment for a brain contusion and mild acute subdural hematoma, and was discharged home after 6 days. However, 9 days after the injury, the patient developed back pain, weakness in both lower limbs, and urinary incontinence and was brought to our hospital. A computed tomography scan on admission displayed a high-density area in the thoracolumbar spinal canal, and magnetic resonance imaging 2 weeks after the fall displayed a spinal subdural hematoma from 8th thoracic to sacral 2nd, with a hyperintensity signal on T1weighted image and T2 weighted image and partial low intensity on T2* imaging. On day 22 after the injury, lumbar drainage was performed, and a motor-oil-like hematoma was aspirated. A total of 330 mL of hematoma content was drained for 3 days. Immediately after treatment, the patient's back pain and lower limb weakness improved, and imaging confirmed the disappearance of the spinal subdural hematoma. Most reported cases to date of chronic spinal subdural hematoma were treated with invasive laminectomy for hematoma removal. In the present case, the authors suspected this condition from the late subacute stage of onset and were able to cure the patient with minimum invasive lumbar drainage after diagnosis of liquefaction of the hematoma by magnetic resonance imaging.

Pathogenesis of Spinal Subdural Hematoma Based on Histopathological Findings: A Case Report

Spinal subdural hematoma is a rare condition whereas intracranial chronic subdural hematoma is well-recognized and documented in clinical settings. Despite various theories that have been proposed, the exact pathogenesis of spinal subdural hematoma remains to be elucidated. Herein, we report a rare case of spinal subdural hematoma with a co-existing intracranial chronic subdural hematoma and deduce its etiology using histopathological findings. A 76-year-old Japanese man with slight hemiparesis due to intracranial chronic subdural hematoma underwent burr hole surgery with successful drainage of the hematoma. The patient could not walk unassisted after the surgery. Spinal magnetic resonance imaging was performed, revealing a subdural hematoma extending from the T11 to S2 levels. The patient subsequently underwent the evacuation of spinal subdural hematoma 12 days after initial surgery. Intraoperatively, we identified a dark liquefied hematoma with capsule formation. Histological examination of the resected capsule revealed loose fibrovascular tissues comprising capillaries, collagen fibers, a small number of macrophages, and hemosiderin deposits. These findings were very similar to the pathology of intracranial chronic subdural hematoma so the pathogenesis of spinal subdural hematoma in this case was considered identical to that of subacute or chronic subdural hematoma. The patient was transferred to a rehabilitation hospital, and 4 months after the lumbar surgery, no recurrence was observed in the magnetic resonance imaging examination. Subacute or chronic spinal subdural hematoma may result from various pathogeneses that clinicians should consider for correct diagnosis and appropriate management. Our case provides important insights into the pathogenesis of subacute or chronic spinal subdural hematoma.

Concomitant spontaneous spinal and posterior fossa subdural hematoma in an 11-year-old child with aplastic anemia: a case report and review of literature

PURPOSE

The current article describes an 11-year-old male who has aplastic anemia with an extremely rare condition, that is, concomitant posterior fossa SDH and spinal SDH.

METHODS

This is a case report and review of literature.

CASE PRESENTATION

This case presents an 11-year-old male known to have aplastic anemia complained of neck and back pain, headache, and persistent vomiting for 3 days. He had no history of head or spine trauma at all. His parents are relatives "positive consanguinity," and his sister suffers from aplastic anemia. Clinical examination revealed severe pallor at the time of presentation, with no neurologic or locomotor deficit and positive Kernig's sign.

CONCLUSION

Patients with aplastic anemia or any bleeding disorder conditions should be investigated thoroughly if symptoms denoted a CNS pathology. Concomitant cranial and spinal SDH rarely occurs, and more studies are advocated to be structured to investigate the specific pathophysiology and etiologies of this condition.

Lumbosacral subdural hematoma associated with cranial subdural hematoma and craniocerebral surgery: Three cases and a systemic literature review

OBJECTIVE

The authors aim to focus on lumbosacral subdural hematoma (SDH) associated with cranial subdural hematoma and craniocerebral surgery, which has been rarely reported.

MATERIAL AND METHODS

They present 3 cases of lumbosacral SDH, including 2 associated with cranial chronic SDH and 1 following craniotomy for neck clipping of cerebral aneurysm. Using a PubMed search, they also provide a systemic literature review to summarize pathogenesis, treatment and outcome.

RESULTS

All cases presented with bilateral radiating leg pain, and recovered completely by conservative managements. Predisposing factors were trauma, anticoagulant therapy and brain atrophy. Literature review revealed 54 such cases, in which 28 cases associated with cranial SDH and 26 cases associated with craniocerebral surgery. In both group, main symptoms were low back and radiating leg pain, and sensorimotor deficits. Regardless of treatments, conservatively or surgically, outcome was favorable. Migration of cranial hematoma is most supported pathogenesis, while intracranial hypotension due to cerebrospinal fluid overdrainage procedures may also be a contributing factor for cases associated with craniocerebral surgery.

CONCLUSIONS

Lumbosacral SDH should be considered in patients present with unexpected low back and radiating leg pains associated with cranial SDH and craniocerebral surgery. Conservative treatment would be reasonable for cases with mild symptoms as the first treatment of choice.

Effect of Different Factors on the Short-Term Outcome of Chinese Patients With Primary Chronic Subdural Hematoma at Different Age Groups: A Two-Center Retrospective Study

Background

The incidence of symptomatic chronic subdural hematoma (CSDH) is increasing in Chinese aging population, but its clinical and demographic knowledge is still lacking. This study sought to outline the clinical and demographic data of CSDH patients from two medical centers in Tianjin and Chongqing to provide a better understanding for CSDH treatment in China.

Methods

Age, sex, etiologies, conscious level on admission, treatment strategies, outcome at discharge, recurrence, and concomitant disease of enrolled patients were recorded. The data were further analyzed after the patients were sub-grouped into young/middle (less than 60 years old) and old (over than 60 years old) age groups.

Results

A total of 1281 CSDH patients were enrolled. Of these, 85.01% were male and 51.91% were aged between 60 and 80 years. 57.61% patients encountered head trauma before diagnosing CSDH. The top three clinical symptoms at admission were headache (58.55%), dyskinesia (36.92%), and dizziness (33.96%). Headache as well as dizziness often happened in young/middle age group, while dyskinesia often occurred in the old age group. The most common concomitant diseases were cardio-cerebrovascular system diseases (41.14%). The concomitant respiratory diseases in aged patients led to unfavorable outcomes (p = 0.049, OR:0.357). The prognosis of old age subgroup receiving conservative treatment was better than those who received burr-hole drainage treatment (p < 0.015, OR:4.091).

Conclusion

CSDH mostly occurs in aged and male population with a history a head trauma. The respiratory disease often results in unfavorable outcomes in aged patients. Conservative treatment might benefit some patients.

Multiple Spinal Chronic Subdural Hematomas Associated with Thoracic Hematomyelia: A Case Report and Literature Review

BACKGROUND

Chronic subdural hematoma (CSDH) is uncommon in the spine. Most spinal CSDHs occur as solitary lesions in the lumbosacral region. We report a rare case of multiple spinal CSDHs associated with hematomyelia. The diagnostic and therapeutic management of these complex spinal CSDHs is reviewed as well as the pertinent literature.

CASE DESCRIPTION

A 79-year-old woman on warfarin therapy presented with lower back pain and progressive lower extremity weakness that had developed in the previous 2 weeks. She subsequently developed paraplegia and urinary incontinence. Thoracolumbar magnetic resonance imaging showed a CSDH from T12-L3 compressing the cauda equina. Single-shot whole-spine magnetic resonance imaging showed another CSDH and hematomyelia at T2-3. She underwent L2-3 hemilaminectomy, which revealed a liquefied subdural hematoma. Delayed T2 laminectomy exposed an organized subdural hematoma and xanthochromic hematomyelia. After each surgery, the patient showed significant motor recovery. Finally, the patient could walk, and the urinary catheter was removed.

CONCLUSIONS

Spinal CSDH may occur in multiple regions and may be associated with hematomyelia. Whole-spine magnetic resonance imaging is useful to examine the entire spine for CSDH accurately and thoroughly. Comprehensive surgical exploration of all symptomatic hematomas may restore neurologic functions even with delayed surgery.