Spinal Spinal Subdural Hematoma Research Articles

Post-traumatic spinal hematoma in ankylosing spondylitis.

The purpose of this study is to examine the incidence, location, and magnetic resonance imaging (MRI) features of spinal epidural hematoma (SEH) and spinal subdural hematoma (SSH) in post-traumatic ankylosing spondylitis (AS) patients. A total of 2256 consecutive referrals for urgent and emergency MRI scans of the spine over a period of eight years and ninemonths were manually reviewed for any mentions indicating axial ankylosis and post-traumatic spinal hematoma. We found 164 patients with ankylosed spines complicated by spinal fracture, of whom 32 had AS. Of the 132 excluded patients, 80 had diffuse idiopathic skeletal hyperostosis (DISH). The primary outcome was the presence of spinal hematoma, and the secondary outcome was spinal canal narrowing and spinal cord impingement. Two musculoskeletal radiologists and one fellow in musculoskeletal radiology reviewed the images for the presence of spinal hematoma and related signal characteristics, blinded to one another and initial reports. Of 28 post-traumatic AS patients, 19 had SEHs and five had spinal SSHs. There was a statistically significant difference between Frankel grades before and after surgery in respect of neurological improvement (p = 0.008). Patients who had radiologically proven spinal cord impingement showed more severe neurological deficits (p = 0.012). Hematomas with T1 heterogeneity showed a significantly increased delay (p = 0.047) between injury and imaging, while other signal characteristics were only approximate. Both SEH and SSH are common complications in post-traumatic AS patients. Patients benefit from surgery, but the relevance of spinal hematoma as a separate factor causing neurological deficit remains unclear.

A delayed-onset intracranial chronic subdural hematoma following a lumbar spinal subdural hematoma

Rationale:A spinal subdural hematoma (SDH) is rarely complicated with an intracranial SDH. We found only 7 cases of spontaneous concurrent lumbar spinal and cranial SDHs, in which lumbar symptoms occurred before head symptoms.Patient concerns:We describe a 77-year-old man with spontaneous concurrent spinal and cranial SDHs, in whom the spinal SDH was identified 30 days before the intracranial chronic SDH.Diagnosis:Magnetic resonance imaging showed a spinal SDH at L4/L5. There was no paralysis, and the patient was managed conservatively. About 30 days after the onset of back pain, he experienced tinnitus and visual hallucination. Brain computed tomography showed a chronic SDH and midline shift.Interventions:Burr-hole evacuation was performed, and the patient's condition improved.Outcomes:At 5 months of follow-up, there was no recurrence of the spinal or intracranial SDH.Lessons:It is important to consider the possibility of intracranial hemorrhage when a spinal SDH is identified.

Traumatic lumbar spinal subdural hematoma

Spinal subdural hematoma (SDH) is a rare and potentially life-threatening condition associated with trauma, lumbar puncture, hemorrhagic disorder, anticoagulant therapy, spinal surgery, tumor, vascular malformations, and spinal or epidural anesthesia. Traumatic SDH is even more uncommon than other forms of SDH with only 10 reported cases in the literature. Following a punch to the head and loss of consciousness, a 35-year-old man reported headaches, right-sided tinnitus, and dull ache behind both eyes. He also experienced sacral pain with stiffness that was exacerbated by movement. MRI showed an isolated lumbar SDH causing mild stenosis. On follow-up, the patient still experienced right-sided tinnitus and bilateral sacral radiculopathy and was prescribed prednisone with repeat MRI at 6weeks. At the next follow-up, the patient’s radiculopathy had resolved completely. Our case illustrates rapid resolution of a posttraumatic spinal SDH after treatment with oral corticosteroids. Recognition of blood products on MRI is vital to diagnosis and expedient treatment. There is agreement that prompt laminectomy with evacuation of SDH should be performed before permanent damage to the spinal cord occurs. Including our patient, 4 of 11 reported cases of thoracic or lumbar SDH resolved with conservative treatment.

Spontaneous Spinal Subdural Hematoma Concurrent with Cranial Subdural Hematoma

A 39-year old female presented with chronic spinal subdural hematoma manifesting as low back pain and radiating pain from both legs. Magnetic resonance imaging (MRI) showed spinal subdural hematoma (SDH) extending from L4 to S2 leading to severe central spinal canal stenosis. One day after admission, she complained of nausea and severe headache. Computed tomography of the brain revealed chronic SDH associated with midline shift. Intracranial chronic SDH was evacuated through two burr holes. Back pain and radiating leg pain derived from the spinal SDH diminished about 2 weeks after admission and spinal SDH was completely resolved on MRI obtained 3 months after onset. Physicians should be aware of such a condition and check the possibility of concurrent cranial SDH in patients with spinal SDH, especially with non-traumatic origin.

Rhabdomyolysis Accompanied by Spontaneous Spinal Subdural and Subarachnoid Hematoma Related to Amphetamine Abuse

Case report. To describe the rare case of a patient presenting with rhabdomyolysis accompanied by spontaneous spinal subdural hematoma (SDH) and subarachnoid hematoma (SAH), presumably caused by amphetamine abuse. Spontaneous SDH accompanied by SAH is an extremely rare condition. To date, only one case describing spinal SAH related to amphetamine abuse has been reported. A 41-year-old man who had a history of amphetamine abuse presented with severe frank pain and lower limb numbness with incomplete paraplegia. Urinary incontinence was subsequently noted. Thoracic-spine magnetic resonance imaging revealed SDHs in the dorsal aspect of the middle thoracic level and along the anterior part of the thecal sac, as well as SAH in the T11-T12 level. Diffuse paraspinal hyperintensity was detected, indicating rhabdomyolysis (creatine phosphokinase levels were also abnormally elevated). The patient responded well to decompression surgical treatment and has since then exhibited no neurologic deficits. We have described a novel case of spinal SDH with SAH. The possible underlying cause of amphetamine abuse is discussed.

Simultaneous cranial subarachnoid hemorrhage and spinal subdural hematoma

We report a rare case of simultaneous cranial subarachnoid and spinal subdural hematoma (SDH) in a 42-year-old man who was on Warfarin therapy after cardiac bypass surgery. Computed tomography at presentation revealed a cranial subarachnoid hemorrhage, and spinal Magnetic Resonance Imaging (MRI) showed a spinal SDH extending from the T6 to L5 segments. He had paraparesis due to spinal cord compression. The patient was managed conservatively due to his poor general condition and was infused with intravenous steroid therapy, but he experienced sudden cardiac arrest 5 hours later after being admitted to the hospital. This case is of interest because of its first presentation of spinal subdural hematoma and cranial subarachnoid hemorrhage simultaneously and it is also the second longest vertebral segmental spread in the literature.

Traumatic Subacute Spinal Subdural Hematoma Successfully Treated With Lumbar Drainage

A case report. To report a rare case of traumatic subacute spinal subdural hematoma (SDH) successfully treated by lumbar drainage. Few reports on traumatic spinal SDH are available in the English literature. The authors present a rare case of traumatic subacute spinal SDH. A 43-year-old man developed severe pain in his back and both legs approximately 3 weeks after a trivial car accident that occurred 1 month before presentation. The patient reported paresthesia in the L5 and S1 dermatomes bilaterally and a walking difficulty because of severe leg pain. He assessed his pain severity as 8 using the visual analog pain score scale. Magnetic resonance imaging of the lumbar spine revealed a spinal SDH extending from the level of the L5 vertebral body to S1-S2 disc space. The spinal SDH was drained by lumbar puncture at the L5-S1 level without surgical exploration. The intensity of the pain decreased considerable immediately, and he was able to walk independently. The patient recovered uneventfully and a follow-up magnetic resonance imaging conducted 4 weeks after the procedure revealed complete disappearance of the hematoma. Traumatic spinal SDH is extremely rare and is usually associated with intracranial injury. Here, the authors report a rare case of traumatic spinal SDH not associated with head injury, which was successfully treated by lumbar drainage.

Spontaneous thoracic spinal subdural hematoma associated with fibromuscular dysplasia

Spontaneous spinal subdural hematoma (SDH) is an uncommon cause of acute spinal cord compression. When it does occur, however, it may have disastrous results and a poor prognosis. The nontraumatic acute spinal SDH usually results from a defect in a hemostatic mechanism (such as coagulopathy or the use of anticoagulant therapy) or from iatrogenic causes (such as spinal puncture). Fibromuscular dysplasia (FMD) is a nonatherosclerotic systemic arteriopathy of unknown cause that typically affects the small and medium arteries in young to middle-aged women. The authors report on their experience with a patient with an acute spontaneous spinal SDH that occurred in conjunction with FMD.

Spinal Subdural Hematoma Following Intracranial Aneurysm Surgery-Four Case Reports-

Four patients presented with rare spinal subdural hematoma (SDH) occurring after intracranial aneurysm surgery and manifesting as postoperative back pain. Magnetic resonance imaging performed from 4 to 11 days after the operation showed acute or subacute thoracolumbar SDH. No patient had risk factors for bleeding at this site (e.g., lumbar puncture, coagulation abnormality). Overdrainage of the cerebrospinal fluid (CSF) was performed for brain retraction during the operation in all four cases. Computed tomography performed during the postoperative period showed a suspicious tentorial subdural hemorrhage in Case 1 and an interhemispheric subdural hemorrhage in Case 3. All four patients received conservative management and their lumbago improved. We hypothesize that CSF hypotension due to overdrainage of CSF and downward migration of intracranial SDH under the influence of gravity were involved in the formation of spinal SDH.

Simultaneous Cranial and Spinal Subdural Hematoma-Case Report-

A 59-year-old male presented with spinal subdural hematoma (SDH) with concomitant cranial chronic SDH manifesting as mild paraparesis and numbness in both lower extremities. Magnetic resonance (MR) imaging showed simultaneous occurrence of cranial and spinal SDHs. The patient was treated conservatively because of poor medical condition and mild neurological symptoms, and recovered well within 1 month. Serial follow-up MR imaging revealed spontaneous resolution of both lesions, with signal intensity changes suggesting the degenerative process of subacute hematoma. The spinal hematoma may have migrated from the cranial lesion. Spinal SDH is a potential sequela of chronic SDH in the cranium.