Spinal subdural hematoma presenting as paraplegia

Abstract

A 76-year-old man who suffered a fall was referred to our emergency department. He presented with sudden severe low back pain, loss of sensation, and urine and fecal incontinence. He had undergone lumboperitoneal shunting owing to hydrocephalus 5 months ago. The hemostatic parameters were normal. There was no coagulation defect. On neurologic examination, there was paraplegia and anesthesia sub L1. Urgent magnetic resonance imaging (MRI) scan of the spine was performed. Thoracolumbar MRI revealed a subacute spinal subdural hematoma (SSDH) from T10 to S1 anterio-lateral to and around the spinal cord in a semicircular pattern with compression (Fig. 1). No underlying tumor or vascular malformation was seen. Emergency laminectomy was performed, which confirmed blood in the subdural space. A subsequent neurologic examination revealed recovery of paraplegia with a power of 4/5, and sensory deficit was recovered completely at postoperative 48 hours. Ten days after the onset, the patient was transferred to our center for further management and rehabilitation. An MRI at 5 weeks showed hematoma resorption (Fig. 2). Subacute spinal subdural hematoma can cause symptoms of cord compression. Therefore, early diagnosis is important. The imaging of choice is MRI because it shows the hematoma location in relation to the dura and spinal cord, and its craniocaudal extension, and it usually shows or rules out an underlying tumor or arteriovenous malformation [1].