Acute Spinal Subdural Hematoma Research Articles

Acute Spinal Subdural Hematoma in a Patient With Multiple Spinal Aneurysms.

HomeStrokeAhead of PrintAcute Spinal Subdural Hematoma in a Patient With Multiple Spinal Aneurysms No AccessCase ReportRequest AccessAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessCase ReportRequest AccessAcute Spinal Subdural Hematoma in a Patient With Multiple Spinal Aneurysms Mohamad Abdalkader, MD, Julie G. Shulman, MD, Anurag Sahoo, MD, Thomas Ford, MD and Thanh N. Nguyen, MD Mohamad AbdalkaderMohamad Abdalkader Correspondence to: Mohamad Abdalkader, MD, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118. Email E-mail Address: [email protected] https://orcid.org/0000-0002-9528-301X Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, MA. (M.A., T.N.N.) Search for more papers by this author , Julie G. ShulmanJulie G. Shulman Neurology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, MA. (J.G.S., A.S., T.F., T.N.N.) Search for more papers by this author , Anurag SahooAnurag Sahoo https://orcid.org/0000-0001-7611-2832 Neurology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, MA. (J.G.S., A.S., T.F., T.N.N.) Search for more papers by this author , Thomas FordThomas Ford https://orcid.org/0000-0002-2160-8248 Neurology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, MA. (J.G.S., A.S., T.F., T.N.N.) Search for more papers by this author and Thanh N. NguyenThanh N. Nguyen https://orcid.org/0000-0002-2810-1685 Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, MA. (M.A., T.N.N.) Neurology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, MA. (J.G.S., A.S., T.F., T.N.N.) Neurosurgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, MA. (T.N.N.) Search for more papers by this author Originally published9 Feb 2023https://doi.org/10.1161/STROKEAHA.122.042120Stroke. 2023;0"Acute Spinal Subdural Hematoma in a Patient With Multiple Spinal Aneurysms." Stroke, , pp. –FootnotesThis manuscript was sent to Jean-Claude Baron, Guest Editor, for review by expert referees, editorial decision, and final disposition.For Sources of Funding and Disclosures, see page xxx.Correspondence to: Mohamad Abdalkader, MD, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118. Email mohamad.[email protected]org Previous Back to top Next FiguresReferencesRelatedDetails Advertisement Article InformationMetrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.122.042120PMID: 36756890 Originally publishedFebruary 9, 2023 Keywordstomographyhematoma, subduralmagnetic resonance imaginganeurysmhemorrhagePDF download Advertisement SubjectsAneurysmMagnetic Resonance Imaging (MRI)Vascular Disease

Open Surgery for Osteoporotic Compression Fracture Within One Month of Single Level Balloon Kyphoplasty.

This study aimed to analyze the reasons for open surgery performed within one month of balloon kyphoplasty (BKP) for osteoporotic compression fractures. This study included 15 patients treated with open surgery within one month of BKP in our institution from 2013 to 2020. Among them, 10 patients underwent BKP in our institution and 5 patients were transferred because of adverse events after undergoing BKP at another hospital. Clinical findings including main indications, neurological deficits, and clinical course were analyzed. All patients were followed up for at least 12 months after surgery (average time 15.5 months, range 12-39 months). Their mean age was 73.7 years and the mean T-score of the spine on bone densitometry was -3.35. The main reasons for open surgery included dislodgement of the cement mass or spinal instability (7 cases, 47%), neural injury due to cement leakage (3 cases, 20%), and spinal cord injury caused by a puncture mistake (3 cases, 20%). Two patients developed acute spinal subdural hematoma, and spinal epidural fluid was pushed out at the back edge of the vertebral body following BKP without signs of major cement leakage into the spinal canal. At the final follow-up, 7 patients with cement mass dislodgement showed complete improvement of related symptoms after posterior fusion with screw fixation. Among the 8 patients with neural injury, 6 improved; however, 2 remained at the same American Spinal Injury Association level. The main reasons for open surgery were cement mass dislodgement and neural injury caused by puncture errors or cement leakage into the spinal canal. It should be noted that proper selection of cases, detailed imaging evaluation, and optimal surgical techniques are key to reducing open surgery after BKP.

Non-traumatic Spontaneous Spinal Subdural Hematoma in a Patient with Acute Paraplegia

Acute non-traumatic spinal subdural hematoma (SSDH) is a rare clinical condition in the emergency medicine practice and difficult to diagnose during the primary physical examination. It mostly occurs at thoracal vertebra levels due to trauma, use of anticoagulants, medical procedures such as acupuncture, arteriovenous malformations, hematological disorders or space-occupying lesions. Here, we discussed an elderly female patient who was not on anticoagulant and described sudden loss of muscle strength and sensation in both lower extremities. Initial laboratory and imaging including brain computerized tomography (CT) and magnetic resonance imaging (MRI) were in normal range. Her secondary examination revealed anesthesia under the T4 dermatome level. Cervical spine-MRI imaging revealed a subdural hematoma significantly compressing the spinal cord on the C7-T1 dermatome segments. Any emergency neurosurgical intervention was not considered and the patient was interned in the neurosurgical clinic for conservative treatment and further examination. Patient , with no progress seen in consecutive MRI scans, was discharged after offering an outpatient check-up. We recommend secondary physical examination in emergency department (ED). In the case of appearance of sensory deficits of certain dermatomes, spine-MR imaging may lead to put the diagnose early in ED.

Acute spontaneous spinal subdural hematoma presenting with Takotsubo cardiomyopathy: a rare case report and literature review.

Spontaneous spinal subdural hematoma (SSDH) is a rare and dangerous intraspinal hematoma that usually occurs in the thoracic vertebra. The influence of early cardiovascular changes secondary to spinal cord injury is an important emergent issue.Herein, we report a case of a middle-aged woman with clinical manifestations of back pain and motion and sensory disturbances below the level of spinal cord compression. During the disease course, she also developed changes indicative of myocardial injury, such as tachycardia, markedly increased concentrations of brain natriuretic peptide and cardiac troponin I, and a decreased left ventricular ejection fraction, which were consistent with the diagnosis of Takotsubo cardiomyopathy (TTC). After the administration of supportive therapies, the symptoms of myocardial injury rapidly resolved. With the absorption of SSDH, the symptoms and clinical signs were alleviated. We also reviewed the literature on cases of concomitant SSDH and TTC.This rare case broadens the symptom spectrum of SSDH and highlights the need for clinicians to be aware of concomitant SSDH and TTC. Initial conservative treatment is a viable option for SSDH with concomitant TTC. However, urgent surgery may be a better option if the SSDH progressively enlarges and causes spinal cord compression.

Spontaneous acute spinal subdural hematoma in patient on oral anticoagulant therapy

Introduction: Spontaneous spinal subdural hematoma as a result of coagulation deficit is a very rare and serious condition, with an overall incidence of less than 1%. Symptoms can vary according to the level of the bleed. Prompt recognition of the presence of spinal subdural hematoma is crucial for treatment. MRI is the investigation of choice for diagnosis as well as for planning the surgery. The differential diagnosis includes abscess, lipomatosis, significant discal hernia and tumours. There are no definite guidelines for the management of spinal subdural hematomas. In cases with serious neurological deficits, prompt surgical evacuation may lead to the resolution of symptoms and complete neurological recovery.
 Case report: We present a case of a 75-years-old man with bilateral lower limb radiculopathy, paresthesias, and spinal claudications for four days, progressing to bilateral paraplegia with urine incontinency. The patient was diagnosed with cauda equina syndrome due to spontaneous spinal subdural hematoma in the region from Th12 to L2. He was immediately operated and the subdural hematoma was evacuated. Minimal recovery was achieved and the patient was referred for further rehabilitation with severe paraparesis and urine incontinence.
 Conclusion: Early diagnosis of spinal subdural hematoma is essential for treatment. Any delay of correct diagnosis can lead to a devastating neurological deficit. Spontaneous spinal subdural hematoma is one of the rare conditions where an emergency MRI is indicated and crucial for diagnosis.

A case of treatment of acute spontaneous spinal subdural hematoma in a patient with the novel coronavirus COVID-19. Literature review

The aim of the work is to describe a case of spontaneous subdural spinal hematoma surgical treatment in a patient with a new coronavirus infection COVID-19, manifested by compression myeloradiculopathy. Materials and methods. In patient N., 70 years old, during the treatment of a new coronavirus infection COVID-19, signs of myelopathy from the dermatome level were revealed. Subdural hematoma was diagnosed at the Th7-L4 level with compression of the dural sac, ponytail and left spinal nerves at the Th12-L2 vertebral level. Results. Performed in the volume of decompressive laminectomy L1, removal of subdural hematoma with a good result in the form of restoration of spinal cord function. Early rehabilitation was carried out in the Department of neurosurgery. Conclusion. Spinal subdural hematomas are extremely rare. We have not found any reports of spinal hematomas in patients with COVID-19 in the Russian-language literature. Alertness to possible hemorrhagic complications in patients with a new coronavirus infection receiving anticoagulants, rapid diagnosis in a multidisciplinary hospital will allow timely neurosurgical care and achieve a good functional result.

Risk Factor Analysis and Surgical Outcomes of Acute Spontaneous Spinal Subdural Hematoma. An Institutional Experience of Four Cases and Literature Review

Spontaneous spinal subdural hematoma (SSSDH) is exceedingly rare, with significant morbidity in most patients. Acute neurologic deficit in the context of a SSSDH is considered a neurosurgical emergency. We performed a literature review and compared the results with our institutional experience to evaluate the risk factors and neurologic outcomes of SSSDH. We retrospectively collected the medical, radiologic, and surgical information of 4 patients with SSSDH who were operated on in our neurosurgical unit. A literature review of surgically managed patients with SSSDH and their neurologic outcomes was performed. Ordered logistic regression statistics were used to study the risk factors influencing the postoperative Domenicucci grade. A total of 112 patients were evaluated, with a female/male ratio of 1.3:1. Mean patient age was 60.25 years. Our analysis of the data showed that the cohort of patients presenting with bladder dysfunction in addition to paraparesis were found to have worse neurologic outcomes postoperatively. Adjusted analysis identified 3 clinical characteristics that influenced surgical outcome: cervical SSSDH (P= 0.029), neurologic deficit (P < 0.001), and anticoagulation medication (P < 0.001). This review shows that patients aged ≥60 years and on anticoagulation are at an increased risk of sustaining a spontaneous subdural spinal hematoma without history of trauma. To our knowledge, this is also the first study to show a presenting symptom of bladder dysfunction as a significant risk factor for poor surgical outcome in SSSDH. Our study supports surgical evacuation of acute SSSDH in the presence of these risk factors.

Acute idiopathic spinal subdural hematoma: What to do in an emergency?

Acute spinal cord compression usually results from trauma, infection, or cancer. Spinal subdural hematoma is an uncommon cause of spinal cord compression that occurs after spine trauma or spinal invasive procedure, especially in context of coagulopathy. In the following reported case, an 82-year-old woman with a history of rapidly progressive paraparesis after a sudden middle back pain, with no previous trauma or coagulopathy, due to an acute spontaneous spinal subdural hematoma. In fact, the main difficulty was to determine, in an emergency situation, the right strategy to identify both the lesion and its cause to adapt therapeutics. This case not only provides an illustrative unusual condition in an emergency department but also a challenging discussion to choose the right treatment for a sudden neurological impairment. According to a literature review of the idiopathic cases of spinal subdural hematomas without coagulopathy, the clinical outcome depends on severity of neurological impairment. MRI is the main examination to perform in an emergency. Thus surgical evacuation should be performed in emergency in patients presenting with severe neurological impairment.

Acute spinal subdural hematoma following lumbar puncture: A case report and review of literature

Background: Lumbar puncture is a common procedure than can have devastating complication. Acute spinal subdural hematoma is a rare complication of lumbar puncture. This diagnosis must be considered when acute onset paraplegia and sphincter disorders occurring after lumbar puncture.

Posttraumatic Acute Spinal Subdural Hematoma of the Spine

AbstractAcute spinal subdural hematoma (ASSH) is a rare cause of spinal cord compression and neurologic deficits. The authors report a case of 23-year-old male patient who developed ASSH following spinal injury and discuss the characteristic imaging findings of ASSH. Magnetic resonance imaging (MRI) of the spine showed hypointense collection on T2W images seen posteriorly extending from inferior endplate of C5 to superior endplate of D3 with preservation of the epidural fat signal. The patient underwent surgical evacuation of the hematoma and made a good recovery in his neurological functions.

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

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.

A Commentary on 'Acute Non-traumatic Spinal Subdural Hematomas'

A Commentary on 'Acute Non-traumatic Spinal Subdural Hematomas'

A case report of acute spinal subdural hematoma

A case report of acute spinal subdural hematoma

Spinal Spot Sign

A marker predictive of hematoma expansion in the central nervous system could aid the selection of patients for hemostatic or surgical treatment. Here, we present a 83-year-old patient with acute spinal subdural hematoma with paraparesis progressing to paraplegia. A contrast extravasation within the intraspinal hematoma was visualized on spinal MR indicating active bleeding (spinal spot sign). A second acquisition of contrast-enhanced MR images showed progression of contrast extravasation helping to different active bleeding from spinal arteriovenous malformations/fistula. A "spinal spot sign" may be important for treatment decisions, notably in patients with incomplete neurological deficits at the time of imaging.

Intracranial vasospasm associated with acute spontaneous spinal subdural hematoma

Intracranial vasospasm associated with acute spontaneous spinal subdural hematoma

Acute Spinal Subdural Hematoma after Vertebroplasty: A Case Report Emphasizing the Possible Etiologic Role of Venous Congestion

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.

Atraumatic acute spinal subdural hematoma and oral anticoagulation therapy

Paulino, Carl B.a; Russo, Christena; Abraham, Robya; Naziri, Qaisa; Merola, Andrewb Author Information

Acute Nontraumatic Spinal Subdural Hematoma due to Warfarin

Anticoagulant drugs have been identified in the etiology of acute nontraumatic spinal subdural hematoma. The number of new cases is increasing with the increased use of them around the worldwide. It is was reported that the risk of bleeding increases as INR rises for warfarin treated patients, particularly if the INR exceeds for 4

Acute Spinal Subdural Hematoma Subsequent To Posterior Lumbar Fusion

Objective: To report a rare case of post-operative cauda equina syndrome subsequent to lumbar decompression and reconstruction, and review the relevant anatomical causes of spinal subdural hematoma. We present a case report of an acute spinal subdural hematoma, following surgical decompression and fusion. The etiology of spinal subdural hematoma after spinal surgery is controversial. We propose that violation of the dural-arachnoid interface is a likely mechanism of this complication. Summary of background data: Spinal subdural hematoma (SSDH) is a very rare postoperative complication of surgical decompression. We report the presentation of acute SSDH presenting with acute cauda equine, following lumbar decompression and reconstruction in a patient lacking risk factors for this rare complication. Methods: A 72 year old man with a history of prior L2-5 laminectomy presented with persistent lower back and left lower extremity radicular pain, due to lumbar spondylosis with foraminal stenosis due to synovial cyst, and lumbar disc herniation. He underwent a revision L2-5 laminectomy with foramintomies, L3-4 synovial cyst resection, and L3-4 posterolateral instrumented fusion. Small incidental duratomy without arachnoid fenestration and without cerebrospinal fluid extravasation, was noted and repaired intraoperatively. On post-operative day four, the patient presented with acute cauda equina syndrome, found to be associated with an acute dorsal lumbar subdural hematoma. Results: After emergent evacuation of the hematoma, patient had immediate resolution of symptoms, and continued to demonstrate dramatic improvement after 1-year follow-up. Conclusions: Despite its low incidence, SSDH should be considered in the setting of acute cauda equina syndrome, following surgical decompression. Prompt evacuation of hematoma is associated with good prognosis. The etiology of SSDH post spinal surgery is controversial. Violation of the dural-arachnoid interface and destruction of local neurothelial cells is the suspected etiology of this very rare complication.

Spinal subdural hematoma as a complication of spinal surgery: can it happen without dural tear?

Post spinal surgery subdural hematoma is a rare entity. This is a report of a case of acute post-operative spinal subdural hematoma, without any dural injury. The case was managed expectantly and went on to complete resolution of the hematoma and full clinical recovery.