Spinal Subarachnoid Hematoma Research Articles

Spinal subarachnoid hematoma involving a thoracic ventral dural defect: illustrative case.

Spinal subarachnoid hematoma of unknown origin is rare. Superficial siderosis has been associated with chronic bleeding from spinal dural defects; however, the relationship between these defects and spinal subarachnoid hematoma remains unclear. A 32-year-old woman presenting with severe back pain and leg weakness exhibited an extensive thoracic spinal hematoma with spinal cord compression on magnetic resonance imaging. Emergency surgery was performed, which revealed a ventral subarachnoid hematoma that was evacuated. A ventral dural defect at the hematoma site and venous bleeding from the surrounding area were observed. Hemostasis was achieved and the defect closed. After surgery, her neurological symptoms quickly resolved. Postoperative spinal angiography showed no vascular lesions. Like superficial siderosis, ventral spinal subarachnoid hematoma can be caused by a spinal dural defect. https://thejns.org/doi/10.3171/CASE24435.

Paraplegia after lumbar puncture

•Lumbar puncture is a very common and safe procedure. •Clopidogrel increased the risk of haemorrhage but serious side effect are rare. •Spinal subdural subarachnoid diffuse haematoma have been very rarely reported.

Spinal Subarachnoid Hematoma After Spinal Anesthesia

The occurrence of spinal subarachnoid hematoma (SSH) after lumbar puncture for anesthesia is a rare complication and in most cases results from difficult spinal anesthesia. Predisposing factors are: presence of tumors or vascular malformations within the spinal canal, coagulopathies, use of antiplatelet and/or anticoagulant therapy, direct spinal cord trauma, spinal canal stenosis, combined spinal anesthesia, multiple and difficult traumatic punctures. We report a case of a patient which after spinal anesthesia for orthopedic surgery developed cauda equina syndrome postoperatively. The patient was submitted to lumbosacral MRI and diagnosed with SSH. Emergency surgical treatment was performed, with clinical and neurological improvement in the immediate postoperative period. A review of the literature was conducted aiming to discuss the pathophysiology and etiological factors involved, as well as aspects related to the diagnosis, treatment and prognosis of this rare clinical condition.

Iatrogenic Spinal Subarachnoid Hematoma after Diagnostic Lumbar Puncture.

Spinal subarachnoid hematoma (SSH) following diagnostic lumbar puncture is very rare. Generally, SSH is more likely to occur when the patient has coagulopathy or is undergoing anticoagulant therapy. Unlike the usual complications, such as headache, dizziness, and back pain at the needle puncture site, SSH may result in permanent neurologic deficits if not properly treated within a short period of time. An otherwise healthy 43-year-old female with no predisposing factors presented with fever and headache. Diagnostic lumbar puncture was performed under suspicion of acute meningitis. Lumbar magnetic resonance imaging was performed due to hypoesthesia below the level of T10 that rapidly progressed after the lumbar puncture. SSH was diagnosed, and high-dose steroid therapy was started. Her neurological symptoms rapidly deteriorated after 12 hours despite the steroids, necessitating emergent decompressive laminectomy and hematoma removal. The patient’s condition improved after the surgery from a preoperative motor score of 1/5 in the right leg and 4/5 in the left leg to brace-free ambulation (motor grade 5/5) 3-month postoperative. The patient was discharged with no neurologic deficits. Critical complications such as SSH can be fatal. Therefore, a patient undergoing lumbar puncture must be carefully observed. A hematoma that convincingly compresses the spinal cord or cauda equina on imaging results requires early surgical decompression and hematoma removal.

Lumbar Subarachnoid Hematoma Following an Epidural Blood Patch for Meningeal Puncture Headache Related to the Implantation of an Intrathecal Drug Delivery System

Persistent meningeal puncture headache (MPH) is a known complication following both intentional and unintentional puncture of the dura mater. We present a case of persistent MPH following implantation of an intrathecal drug delivery system (IDDS). Two separate epidural blood patches (EBP) were performed under radiographic guidance with contrast visualization of the epidural space on postoperative days 16 and 28, respectively. The case was complicated by the development of a symptomatic lumbar subarachnoid hematoma diagnosed on postoperative day 35. The patient subsequently underwent a laminectomy, evacuation of the hematoma, and explanation of the IDDS. This case illustrates a potential unique morbidity associated with the EBP in a patient with an IDDS. The report concludes with a brief review of MPH followed by a discussion of possible mechanisms underlying this complication. Key words: Epidural blood patch, post dural puncture headache, meningeal puncture headache, complications, spinal subarachnoid hematoma, intrathecal drug delivery, implantable pain therapies, ziconotide, tinnitus, pain, pain procedures

Intracranial Extension of Spinal Subarachnoid Hematoma Causing Severe Cerebral Vasospasm

Spinal subarachnoid hemorrhages (SAH) can extend into the intracranial subarachnoid space, but, severe cerebral vasospasm is rare complication of the extension of intracranial SAH from a spinal subarachnoid hematoma. A 67-year-old woman started anticoagulant therapy for unstable angina. The next day, she developed severe back pain and paraplegia. MRI showed intradural and extramedullar low signal intensity at the T2-3, consistent with intradural hematoma. High signal intensity was also noted in the spinal cord from C5 to T4. We removed subarachnoid hematoma compressing the spinal cord. The following day, the patient complained of severe headache. Brain CT revealed SAH around both parietal lobes. Three days later, her consciousness decreased and left hemiplegia also developed. Brain MRI demonstrated multiple cerebral infarctions, mainly in the right posterior cerebral artery territory, left parietal lobe and right watershed area. Conventional cerebral angiography confirmed diffuse severe vasospasm of the cerebral arteries. After intensive care for a month, the patient was transferred to the rehabilitation department. After 6 months, neurologic deterioration improved partially. We speculate that surgeons should anticipate possible delayed neurological complications due to cerebral vasospasm if intracranial SAH is detected after spinal subarachnoid hematoma.

Spinal Subarachnoid Hematoma as a Complication of an Intramuscular Stimulation : Case Report and a Review of Literatures

Intramuscular stimulation (IMS) is widely used to treat myofascial pain syndrome. IMS is a safe procedure but several complications have been described. To our knowledge, spinal subarachnoid hematoma has never been reported as a complication of an IMS. The authors have experienced a case of spinal subarachnoid hematoma occurring after an IMS, which was tentatively diagnosed as intracranial subarachnoid hemorrhage because of severe headache. Patient was successfully treated with surgery. Here, we report our case with a review of literature.

Spinal subarachnoid hematoma after spinal anesthesia

Spinal subarachnoid hematoma after spinal anesthesia

Cervical spinal subarachnoid hematoma caused by head injury

Spinal subarachnoid hematoma (SSAH) is a rare condition. Most of the cases are associated with some predisposing factors such as coagulopathy or iatrogenic mechanisms. To the best of our knowledge, only 9 cases of traumatic SSAH without coagulopathy have been reported in the English literature. We add hereby a case of cervical SSAH after blunt head trauma in a 63-year-old female, with tetraparesis developing in 3 days after the head injury. Evacuation of the SSAH was performed. The postoperative course was uneventful, but the patient's neurological status had no improvement. No vascular lesion accounting for the SSAH was found. The possible causes of SSAH and the treatment outcome are discussed and compared with the results of the published case reports. Since SSAH cases are extremely rare, the diagnosis may be delayed if no obvious clinical neurologic deficits are present initially. Emergency room physicians should be aware of the possibility of SSAH in image studies.

Spinal subarachnoid hematoma in a woman with HELLP syndrome: a case report

IntroductionSubarachnoid hemorrhages of spinal origin are extremely rare during pregnancy. We present the case of a patient with hemolytic anemia, elevated liver enzymes and low platelet count (the so-called HELLP syndrome), a potentially life-threatening complication associated with pre-eclampsia, who presented with an idiopathic spinal subarachnoid hematoma.Case presentationAt 29 gestational weeks, a 35-year-old Japanese woman was diagnosed with HELLP syndrome based on bilateral leg paralysis, diminished sensation and reflexes, and laboratory findings. The pregnancy was immediately brought to an end by Cesarean delivery. Post-operatively, an MRI scan revealed a space-occupying lesion in her thoracic spinal canal. Emergency decompression was followed by total laminectomy. A subarachnoid hematoma, partially extending as far as the ventral side, was removed. After thorough washing and drain placement, the operation was completed with the suturing of artificial dura mater. Eight months post-operatively, her lower extremity sensation had improved to a score of 8 out of 10, but improvements in her muscular strength were limited to slight gains in her toes. MRI scans taken two months post-operatively revealed edematous spinal cord changes within her medulla.ConclusionsA subarachnoid hematoma during pregnancy is extremely rare, possibly due to increased coagulability during pregnancy. However, this complication is potentially devastating should a clot compress the spinal cord or cauda equina. While several causes of hematoma have been proposed, we speculate that the factors underlying hemorrhagic diathesis in our case were the decreased platelet count characteristic of HELLP syndrome and vascular fragility due to elevated estrogen levels, in addition to increased abdominal pressure during pregnancy and pressure from the gravid uterus resulting in ruptured vessels around the spinal cord. In cases displaying a progressive lesion and severe neurological signs, prompt decompression is crucial.

Acute spinal subarachnoid haematoma following spinal anaesthesia treated conservatively: case report

Acute spinal subarachnoid haematoma following spinal anaesthesia treated conservatively: case report

Angiographically Occult Vascular Malformation of the Cauda Equina Presenting Massive Spinal Subdural and Subarachnoid Hematoma

We report a case of a non traumatic spinal subdural hematoma or subarachnoid hematoma manifesting as lumbago, leg pain and bladder dysfunction that showed angiographically occult vascular malformation (AOVM). Although the spinal angiogram did not reveal any vascular abnormality, the follow-up magnetic resonance image showed AOVM. Complete surgical removal was performed due to the aggravated bladder dysfunction. This case highlights the need to consider bleeding due to spinal AOVM, even when angiography is negative.

Intraoperative Spinal Subarachnoid Hematoma in a Patient With Cervical Ossification of the Posterior Longitudinal Ligament

Case report. To report a surgically treated case of cervical ossification of the posterior longitudinal ligament (OPLL), in which a spinal subarachnoid hematoma (SSAH) developed intraoperatively but was successfully treated. Previous reports have indicated that trauma, lumbar puncture, vascular lesions such as arteriovenous malformation, neoplastic lesions, and coagulopathy can cause SSAH. To the best of our knowledge, there has been no report that describes the occurrence of SSAH during anterior decompression surgery of the cervical spine. A 52-year-old man with cervical myelopathy caused by OPLL underwent surgery for anterior decompression from C2/3 to C6/7. Immediately after the OPLL floating procedure, cerebrospinal fluid leakage and massive bleeding occurred at right edge of the OPLL at the C3-C4 level. After hemostasis, the dura mater at the C5-C6 levels bulged rapidly and became cyanotic. Intraoperative ultrasonographic images showed a high-intensity mass lesion on the ventral side of the spinal cord, indicating an intrathecal hematoma. We incised the dura, found the hematoma under the intact arachnoid, and removed it. We then found that the bleeding occurred from the radicular artery along the right C4 root. After hemostasis, we performed anterior spine fusion from C2-C7. After surgery, the patient's myelopathy was improved, and no neurologic deficit related to the subarachnoid hematoma was found. This experience suggests that when anterior decompression surgery is performed for cervical OPLL patients, we should consider the possible occurrence of an SSAH. Intraoperative ultrasonography is a useful tool for detecting SSAHs.

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.

Spinal subarachnoid hematoma following spinal anesthesia in a patient with HELLP syndrome

A case of subarachnoid hematoma following spinal anesthesia for cesarean section in a patient with HELLP syndrome is reported. A 39-year-old woman underwent cesarean section under spinal anesthesia for worsening preeclampsia with HELLP syndrome. Despite full recovery from the spinal anesthetic, on the second postoperative day she felt numbness on the posterior aspect of her right leg, noticed she was insensitive to bladder fullness and had mild flaccid paraparesis. Magnetic resonance imaging revealed a spinal subarachnoid hematoma with cauda equina compression. With conservative management she made an almost complete recovery within three months. Serial magnetic resonance imaging showed spontaneous regression of the hematoma. The risk of spinal subarachnoid hematoma following obstetric regional anesthesia is exceedingly small even in a patient with coagulopathy and, to our knowledge, this is only the second reported case following obstetric regional anesthesia. Anesthesia for HELLP syndrome in patients with an adequate platelet count but without disseminated intravascular coagulation is controversial. It is therefore important for clinicians to recognize the symptoms and signs of spinal subarachnoid hematoma to avoid delay in treatment that might result in severe neurological deficit.

Spinal Subarachnoid Hematoma With Hyperextension Lumbar Fracture in Diffuse Idiopathic Skeletal Hyperostosis

A case report of a spinal subarachnoid hematoma (SSAH) associated with hyperextension fractures complicating diffuse idiopathic skeletal hyperostosis (DISH). To report the first case of a SSAH complicating spinal fracture in DISH. A SSAH is very rare condition. And there had been several reports on spinal fractures in DISH through fused spinal segments, but no report related with SSAH associated with spinal fracture in DISH patient. A 78-year-old female patient was admitted for pain in the back and lower limbs and paraparesis after being fall on her back. On simple radiographs, DISH with anterior cortical bone deficit and increased height were presented at the level of L1. MR and Myelography computed tomography images revealed an extension type of fracture with an irregular shaped subarachnoid hematoma within the dura. Differential diagnosis from infection or tumorous condition was required. Durotomy and 1 to 2 laminectomy was performed to improve neurologic symptoms. The posterior yellow ligament was seen partially ossified and adhered to dura without dura tear. The hematoma was found adherent to the nerve roots of the cauda equina and pia mater. After posterior segmental screw instrumentation and fusion from T10 to L3, anterior interbody fusion was performed with extrapleural approach after dissected the 11th rib, using L1 corpectomy and titanium mesh cages. There was no evidence of infection or tumor. After surgery, motor and sensory function of the lower limbs improved remarkably with solid bony union. The first case of a SSAH complicating spinal fracture in DISH is presented. The patient was successfully treated with a staged operation including posterior decompression with fusion and anterior interbody fusion.

Spontaneous Spinal Subarachnoid Hemorrhage with Spontaneous Resolution

Spontaneous spinal subarachnoid hematoma (SSH) is a rare entity to cause spinal cord or nerve root compression and is usually managed as surgical emergencies. We report a case of spontaneous SSH manifesting as severe lumbago, which demonstrated nearly complete clinical resolution with conservative treatment. A 58-year-old female patient developed a large SSH, which was not related to blood dyscrasia, anticoagulation, lumbar puncture, or trauma. Patient had severe lumbago but no neurologic deficits. Because of absence of neurologicl deficits, she was treated conservatively. Follow-up magnetic resonance (MR) image showed complete resolution. Conservative treatment of SSH may be considered if the patient with spontaneous SSH has no neurologic deficits.

Cerebral subarachnoid blood migration consecutive to a lumbar haematoma after spinal anaesthesia

We report the case of a woman who received spinal anaesthesia for peripheral vascular surgery of the lower limbs and subsequently developed a spinal subarachnoid haematoma. Interestingly, low back pain was the only symptom of this spinal subarachnoid haemorrhage. During the following days, blood migrated from the spinal haematoma towards the cerebral subarachnoid spaces. The patient presented with stupor, nausea and vomiting that resolved within 2 weeks with conservative treatment.

Subarachnoid haematoma after spinal anaesthesia mimicking transient radicular irritation: a case report and review

I report a patient with a spinal subarachnoid haematoma after difficult spinal anaesthesia who presented with symptoms of radicular irritation, and who recovered with conservative management. Subarachnoid haematoma is rare after spinal anaesthesia; a literature review found nine cases. In the majority of these cases, spinal anaesthesia had been difficult and unsuccessful. Other risk factors included antiplatelet and anticoagulant therapy, and direct spinal cord trauma. All the previous cases required decompressive laminectomy.

Subacute Spinal Subarachnoid Hematoma after Spinal Anesthesia That Causes Mild Neurologic Deterioration

SPINAL subarachnoid hematoma after lumbar puncture has been reported to occur in the presence of preexisting coagulopathy or anticoagulant therapy. 1-4 Although occult spinal subarachnoid hematoma may be possible, symptom onset generally is acute and dramatic, and it also represents serious complications for hemostatically compromised patients.5"7 We report a patient who developed spinal subarachnoid hematoma after lumbar puncture. However, she had normal blood coagulation profiles and no spinal disorders such as spinal stenosis or spinal fractures. The onset of her symptoms was gradual, and neurologic deterioration was mild. To our knowledge, this is the first report about spinal subarachnoid hematoma with mild and vague symptoms in a hemostatically normal patient.