A case of acute spinal subdural hematoma with subarachnoid hemorrhage: Rapid spontaneous remission, relapse, and complete resolution

Abstract

Abstract Acute spinal subdural hematoma (SSDH) is a rare entity that is usually managed as a surgical emergency; however, we present a case of acute SSDH that resolved rapidly and spontaneously. A 59-year-old man, who was taking antiplatelet and antihypertensive medication, experienced sudden back neck pain, followed by complete paraplegia. The symptoms resolved within minutes and then recurred before resolving completely within several hours. Magnetic resonance imaging (MRI) performed 6 h from onset revealed an intradural spinal hematoma. Lumbar puncture yielded bloody cerebrospinal fluid, confirming the presence of a subarachnoid hemorrhage. Conservative therapy was selected, leading to complete recovery without any sequelae. Follow-up MRI scans obtained 12 days from onset finally confirmed that the spinal hematoma was in the subdural space. In addition to rostrocaudal spreading of bloody components in the subdural space, rupture of the hematoma into the subarachnoid space must have released pressure, compressing the spinal cord. In this case report, we also describe the serial MRI studies and note the limitations of the resolution of spinal MRI in the acute phase.