Spontaneous Spinal Subarachnoid Hemorrhage Research Articles

Management of a recurrent spinal arachnoid cyst presenting as arachnoiditis in the setting of spontaneous spinal subarachnoid hemorrhage: illustrative case.

Spontaneous spinal subarachnoid hemorrhage is a rare pathological entity with a variety of presentations depending on the underlying etiology, which often remains cryptogenic. The literature is sparse regarding the most efficacious treatment or management option, and there is no consensus on follow-up time or modalities. Additionally, there are very few reports that include operative videos, which is provided herein. The authors present a case of spontaneous spinal subarachnoid hemorrhage without an underlying etiology in a patient with progressive myelopathy, back pain, and lower-extremity paresthesias. She presented to our institution, and because of progressive worsening of her symptoms and the development of compressive arachnoid cysts, she underwent thoracic laminectomies for evacuation of subdural fluid, fenestration of the arachnoid cysts, and lysis of significant arachnoid adhesions. Her clinical course was further complicated by the recurrence of worsening myelopathy and the development of a large compressive arachnoid cyst with further arachnoiditis. The patient underwent repeat surgical intervention for cyst decompression with an improvement in symptoms. This case highlights the importance of long-term follow-up for these complicated cases with an emphasis on repeat magnetic resonance imaging. Unfortunately, surgical intervention is associated with short-term relief of the symptoms and no significant nonoperative management is available for these patients.

Spontaneous Spinal Subarachnoid Hemorrhage: Presentation and Outcome

BackgroundSpontaneous spinal subarachnoid hemorrhage (SSAH) is a rare but serious condition that can lead to a variety of medical complications. MethodsUsing the Mayo Clinic Rochester database, consecutive patients admitted to the Mayo Clinic Rochester, Minnesota hospital with spontaneous SSAH (not iatrogenic or traumatic) between January 2000 and December 2015 were retrospectively reviewed. Demographic and clinical data and functional outcomes as categorized by the modified Rankin Scale (mRS) score at the time of discharge and at postadmission follow-up were assessed. ResultsEight patients (median age 70 years, range 51-87) were identified. Seven patients presented with acute back pain or headache. Seven patients had poorly controlled chronic hypertension. Two patients had vasculitis and 1 had an arteriovenous malformation. Complications included cord compression (n = 4), hyponatremia (n = 5), sulcal subarachnoid hemorrhage (n = 2), chronic arachnoiditis (n = 1), vasospasm (n = 1), ischemic infarct (n = 1), and late cord ischemia (n = 1). All patients were managed medically including blood pressure control and repeat imaging. One patient had an aneurysm, which was embolized, and 2 received steroids for vasculitis. One patient died during hospitalization and 1 died within a week of discharge. Five patients had improved and 1 had unchanged mRS score at posthospitalization follow-up. ConclusionsSSAH should be considered in patients with sudden onset of severe back pain and headache, especially if as associated with lower extremity weakness or urinary retention. Our findings suggest that older patients with poorly controlled hypertension are at particular risk for spontaneous SSAH. In our study vascular anomalies were found in 25% of patients, vasculitis in 25%, hyponatremia in 63%, and cord compression in 50%. Cord compression may be managed conservatively. Mortality was 25% in the 3 months following the initial event, primarily due to other medical comorbidities.

Abstract 194: Spontaneous Spinal Subarachnoid Hemorrhage: A Mayo Clinic Case Series

Background: Spontaneous spinal subarachnoid hemorrhage (SSAH) is a rare but serious condition that can lead to a variety of medical complications. Methods: Using the Mayo Clinic Rochester database, patients admitted to the Mayo Clinic Rochester, MN hospital with spontaneous SSAH (not iatrogenic or traumatic) between January 2000 and December 2015 were retrospectively reviewed. Demographic and clinical data and functional outcomes as described by the modified Rankin Scale (mRS) score at the time of discharge and at post-admission follow-up were assessed. Results: Eight consecutive patients (median age 70 years, range 51-87) were identified. Seven patients presented with acute onset back pain or headache. Seven patients had poorly controlled chronic hypertension. Two patients had vasculitis, and one had an arteriovenous malformation (AVM). An increase in blood pressure was observed in all patients during their acute presentation as compared to their baseline outpatient readings. Complications included cord compression (n = 4), hyponatremia (n = 5), sulcal subarachnoid hemorrhage (n = 2), chronic arachnoiditis (n=1), vasospasm (n=1), and late cord ischemia (n = 1). All eight patients were managed medically including blood pressure control and repeat imaging. One patient had an aneurysm which was embolized, and two received steroids for vasculitis. One patient died during hospitalization, one died within a week of discharge, five had improved mRS score at post-hospitalization follow-up and had unchanged mRS of 1 at discharge and follow-up. Conclusions: To our knowledge this is the first compilation of cases of spontaneous SSAH. Risk factors for spontaneous SSAH are hypertension, AVM, vasculitis, coarctation of the aorta, and malignancy. Symptomatic cord compression is not uncommon, but can be managed conservatively.

Spontaneous spinal subarachnoid hemorrhage with residual arachnoid cyst: a case report

Spinal subarachnoid hemorrhage is a rare condition that usually occurs because of secondary causes and idiopathic spontaneous ones are extremely rare. We report a 56-year-old woman who presented with severe headache, neck pain and urinary retention. Magnetic resonance imaging revealed subarachnoid hemorrhage that extended from T1 to lumbar vertebrae. She was treated conservatively and symptoms were resolved within 1 month. An asymptomatic arachnoid cyst was observed on the follow-up magnetic resonance imaging after 3 months with no neurologic deterioration. She was still stable clinically and radiologically at the end of 19 months. Spinal subarachnoid hemorrhage is a surgical emergency, although in some cases a conservative approach may be useful.

Spontaneous spinal subarachnoid hemorrhage after severe coughing: a case report

IntroductionSpinal subarachnoid hemorrhage has many causes including trauma, vascular malformations, aneurysms, spinal cord tumors, coagulation abnormalities, use of anticoagulants, systemic lupus erythematosus, or Behçet’s disease. We report on a rare case of a spontaneous spinal subarachnoid hemorrhage after severe coughing of unknown origin. To the best of our knowledge, this is the first report of spontaneous spinal subarachnoid hemorrhage after severe coughing.Case presentationA 66-year-old Japanese woman initially complained of headache with severe back pain after severe coughing. She was referred to our neurology department 6 days after her first visit to our hospital. No neurological deficits were revealed except for meningism. Computed tomography of her head revealed no abnormality. A lumbar puncture showed bloody cerebrospinal fluid with xanthochromia. Cerebral angiography revealed no abnormality. Magnetic resonance imaging of her lumbar spine revealed subarachnoid hemorrhage. Spinal angiography revealed no abnormality. The diagnosis of spontaneous spinal subarachnoid hemorrhage was made. She recovered with conservative treatment and her neurological status was normal 2 years after the onset.ConclusionsSpontaneous spinal subarachnoid hemorrhage could be caused by rapid changes in intrathoracic and intra-abdominal pressure. Spontaneous subarachnoid hemorrhage should be considered when sudden back pain associated with severe headache develops. Even though emergent surgical decompression is necessary when the neurological state progressively deteriorates, conservative treatment with close monitoring of the symptoms can be recommended for patients with a stable neurological status.

Spontaneous Thoracic Spinal Subarachnoid Hemorrhage Diagnosed with Brain Computed Tomography

Spontaneous thoracic spinal subarachnoid hemorrhage is rare, and thus no useful radiological findings for preoperative diagnosis have been reported. We experienced a patient with spontaneous thoracic spinal subarachnoid hemorrhage. A 37-year-old female presented with sudden-onset paraplegia and numbness in the trunk and bilateral lower extremities. The patient had no past history of trauma, lumbar puncture and bleeding disorder. T2-weighted sagittal magnetic resonance imaging (MRI) of the cervical and thoracic spines showed a mass occupied in the ventral space of spinal cord that was dorsally shifted. The mass extended from C6 to Th6 levels, with its largest size at Th2 level. Thoracic spine T2-weighted sagittal and axial MRI showed that the mass compressed spinal cord and was located in the intradural space. There was no spinal cord tumor and no spinal vascular malformation around the mass. Brain computed tomography (CT) showed a high-density area in the subarachnoid space, indicating the possibility of subarachnoid hemorrhage. Brain MRI showed no ruptured aneurysm. The patient was diagnosed as a spontaneous thoracic spinal subarachnoid hemorrhage and emergency surgery was selected. We performed right-side hemilaminectomy at Th1-Th6 and opened dura mater and arachnoid membrane. Hematoma was found in the ventral space of spinal cord and was removed. One year after surgery, numbness in the trunk and bilateral lower extremities had disappeared but paraplegia remained unchanged. Thoracic spine T2-weighted MRI confirmed no hematoma but showed a newly formed intradural cyst. Preoperative combination of brain CT and thoracic MRI is useful to diagnose thoracic spinal subarachnoid hemorrhage.

Cerebral Vasospasm with Ischemia following a Spontaneous Spinal Subarachnoid Hemorrhage

Cerebral vasospasm is a well-known consequence of aneurysmal subarachnoid hemorrhage (SAH) triggered by blood breakdown products. Here, we present the first case of cerebral vasospasm with ischemia following a spontaneous spinal SAH. A 67-year-old woman, who was on Coumadin for atrial fibrillation, presented with chest pain radiating to the back accompanied by headache and leg paresthesias. The international normalized ratio (INR) was 4.5. Ten hours after presentation, she developed loss of movement in both legs and lack of sensation below the umbilicus. Spine MRI showed intradural hemorrhage. Her coagulopathy was reversed, and she underwent T2 to T12 laminectomies. A large subarachnoid hematoma was evacuated. Given her complaint of headache preoperatively and the intraoperative finding of spinal SAH, a head CT was done postoperatively that displayed SAH in peripheral sulci. On postoperative day 5, she became obtunded. Brain MRI demonstrated focal restricted diffusion in the left frontoparietal area. Formal angiography revealed vasospasm in anterior cerebral arteries bilaterally and right middle cerebral artery. Vasospasm was treated, and she returned to baseline within 48 hours. Spontaneous spinal SAH can result in the same sequelae typically associated with aneurysmal SAH, and the clinician must have a degree of suspicion in such patients. The pathophysiological mechanisms underlying cerebral vasospasm may explain this unique case.

Spontaneous spinal subarachnoid hemorrhage associated with subdural hematoma at different spinal levels

We describe the clinical features and MR-imaging findings of spontaneous spinal subarachnoid hemorrhage located in the lumbar spine associated with subdural hematoma at a higher, thoracic level in a 66-year-old man without neurological deficit. The sequential MR-imaging changes of hemorrhage at various stages in its evolution are portrayed. The possible pathogenetic mechanism for these very unusual, combined hemorrhages in both spinal compartments is discussed.

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.

Spontaneous Spinal Subarachnoid Hemorrhage Secondary to Spinal Aneurysms: Diagnosis and Treatment Paradigm

Isolated spinal aneurysms are rare; only a few have been reported. To the best of our knowledge, this series represents the largest experience with four ruptured spinal aneurysms, all of which were treated surgically. Clinical information from the hospital charts and diagnostic images of four patients with the diagnosis of spinal aneurysms were reviewed from the senior authors' (RFS, JMZ) office database, surgical reports, and radiological imaging database. Follow-up examinations were performed by phone interview, when possible, and by chart review. Between 1997 and 2004, four patients with ruptured spinal aneurysms underwent surgical treatment. All aneurysms were located within the spinal canal and manifested with spinal subarachnoid hemorrhage. No collagen disease, aortic coartaction, arteriovenous fistula, or arteriovenous malformations were identified in these patients. Subarachnoid hemorrhage within the spinal cord can be caused by ruptured aneurysms. Spinal aneurysms are rare, but should be considered within the differential diagnosis of patients with intracranial subarachnoid hemorrhage when cranial angiography is negative. Magnetic resonance imaging and selective spinal angiography are useful for workup, but definitive diagnosis may require surgical exploration.

Spinal subarachnoid hemorrhage attributable to schwannoma of the cauda equina

BACKGROUND Cauda equina syndrome occurring as a result of spontaneous spinal subarachnoid hemorrhage (SAH) from a spinal tumor is reported to be rare. CASE DESCRIPTION A 28-year-old woman presented at our clinic with a history of severe back pain for 10 days, progressive paraparesis, and urinary retention. Her physical examination revealed a mass located intradurally at the level of L1-2 and a massive SAH. An L1-L2, laminectomy and a hemilaminectomy from D9 to D12 were performed and the SAH was evacuated and the cord was decompressed. CONCLUSION At the first year follow-up, her restricted dorsal and plantar flexion continued. Post-gadolinium magnetic resonance imaging revealed no mass.