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Yang JS, Kwon YS, Kim JH, Lee JJ, Seo EM. The Influence of High Blood Pressure on Developing Symptomatic Lumbar Epidural Hematoma after Posterior Lumbar Spinal Fusion Surgery: Clinical Data Warehouse Analysis. J Clin Med 2022; 11:jcm11154522. [PMID: 35956136 PMCID: PMC9369553 DOI: 10.3390/jcm11154522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/25/2022] [Accepted: 07/29/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Determining the risk factors for symptomatic lumbar epidural hematoma (SLEH) is important for preventing postoperative SLEH. However, the relationship between blood pressure and SLEH is still debatable. The purpose of our study was to determine the risk factors for postoperative SLEH, to assess the influence of high blood pressure on developing SLEH after posterior lumbar spinal fusion surgery, and to evaluate the usefulness of big data analysis utilizing a clinical data warehouse (CDW). Methods: The clinical data of patients who had undergone posterior lumbar spinal fusion surgery were acquired from the CDW of Hallym University Medical Center. The acquired clinical data were compared between patients without postoperative SLEH and with postoperative SLEH. Results: Postoperative SLEH that required hematoma evacuation surgery within 72 h after posterior lumbar spinal fusion surgery occurred in 17 (1.3%) of 1313 patients. According to the multivariate logistic regression analysis, the risk factors for postoperative SLEH are platelet count difference (OR 1.28, p = 0.03), postoperative international normalized ratio (INR) difference (OR 31.4, p = 0.028), and postoperative systolic blood pressure (SBP) difference (≥10 mmHg) (OR 1.68, p = 0.048). An increase in postoperative SBP (OR 1.68, p = 0.048) had a statistically significant influence on the occurrence of postoperative SLEH. Conclusions: Big data analysis utilizing a CDW could be useful for extending our knowledge of the risk factors for postoperative SLEH and preventing postoperative SLEH after posterior lumbar spinal fusion surgery.
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Affiliation(s)
- Jin-Seo Yang
- Department of Neurosurgery, Chunchon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24252, Korea;
| | - Young-Suk Kwon
- Division of Big Data and Artificial Intelligence, Institute of New Frontier Research, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea; (Y.-S.K.); (J.-H.K.); (J.-J.L.)
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea
| | - Jong-Ho Kim
- Division of Big Data and Artificial Intelligence, Institute of New Frontier Research, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea; (Y.-S.K.); (J.-H.K.); (J.-J.L.)
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea
| | - Jae-Jun Lee
- Division of Big Data and Artificial Intelligence, Institute of New Frontier Research, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea; (Y.-S.K.); (J.-H.K.); (J.-J.L.)
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea
| | - Eun-Min Seo
- Division of Big Data and Artificial Intelligence, Institute of New Frontier Research, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea; (Y.-S.K.); (J.-H.K.); (J.-J.L.)
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea
- Correspondence: ; Tel.: +82-33-240-5198
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Pathogenesis of spontaneous chronic subdural hematoma of the posterior fossa. Acta Neurol Belg 2022; 122:567-569. [PMID: 34694583 DOI: 10.1007/s13760-021-01827-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/14/2021] [Indexed: 10/20/2022]
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Yokota H, Wajima D, Ida Y. Lumbosacral subdural hematoma associated with cranial subdural hematoma and craniocerebral surgery: Three cases and a systemic literature review. Neurochirurgie 2021; 67:470-478. [PMID: 33450270 DOI: 10.1016/j.neuchi.2020.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 11/18/2020] [Accepted: 12/22/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors aim to focus on lumbosacral subdural hematoma (SDH) associated with cranial subdural hematoma and craniocerebral surgery, which has been rarely reported. MATERIAL AND METHODS They present 3 cases of lumbosacral SDH, including 2 associated with cranial chronic SDH and 1 following craniotomy for neck clipping of cerebral aneurysm. Using a PubMed search, they also provide a systemic literature review to summarize pathogenesis, treatment and outcome. RESULTS All cases presented with bilateral radiating leg pain, and recovered completely by conservative managements. Predisposing factors were trauma, anticoagulant therapy and brain atrophy. Literature review revealed 54 such cases, in which 28 cases associated with cranial SDH and 26 cases associated with craniocerebral surgery. In both group, main symptoms were low back and radiating leg pain, and sensorimotor deficits. Regardless of treatments, conservatively or surgically, outcome was favorable. Migration of cranial hematoma is most supported pathogenesis, while intracranial hypotension due to cerebrospinal fluid overdrainage procedures may also be a contributing factor for cases associated with craniocerebral surgery. CONCLUSIONS Lumbosacral SDH should be considered in patients present with unexpected low back and radiating leg pains associated with cranial SDH and craniocerebral surgery. Conservative treatment would be reasonable for cases with mild symptoms as the first treatment of choice.
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Affiliation(s)
- H Yokota
- Department of Neurosurgery, Nabari City Hospital, 1-178 Yurigaoka Nishi, Nabari, Mie, 518-0481, Japan.
| | - D Wajima
- Department of Neurosurgery, Nabari City Hospital, 1-178 Yurigaoka Nishi, Nabari, Mie, 518-0481, Japan
| | - Y Ida
- Department of Neurosurgery, Nabari City Hospital, 1-178 Yurigaoka Nishi, Nabari, Mie, 518-0481, Japan
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Lumbar Subdural Hematoma Detected After Surgical Treatment of Chronic Intracranial Subdural Hematoma. World Neurosurg 2019; 134:472-476. [PMID: 31756510 DOI: 10.1016/j.wneu.2019.11.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 11/07/2019] [Accepted: 11/08/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Spinal subdural hematoma (SSDH), which can cause lower back pain, leg pain, and leg weakness, is rare and will usually be associated with a bleeding tendency, trauma, spinal vascular malformation, intraspinal tumor, or iatrogenic invasion. Only a few cases of SSDH after intracranial chronic subdural hematoma (CSDH) have been reported. We report a case of lumbar SSDH in the absence of predisposing factors after reoperation for recurrent intracranial CSDH, which improved with conservative treatment. CASE DESCRIPTION Approximately 1 month after falling, a 63-year-old woman was experiencing left hemiparesis and impaired orientation that was diagnosed as right intracranial CSDH using computed tomography. Surgical treatment of the CSDH led to immediate improvement of her symptoms. On postoperative day 29, the right CSDH had recurred with left hemiparesis, and successful reoperation relieved the symptoms within a few hours postoperatively. However, 1 day after the second operation, very small acute subdural hematomas in regions along the left tentorium cerebelli and left falx cerebri were found on computed tomography. On day 31, she complained of sitting-induced bilateral radiating lower limb pain. Magnetic resonance imaging on day 34 showed an acute SSDH at the L4-L5 level and a sacral perineural cyst filled with hematoma, although her radiating pain was showing improvement. She was treated conservatively and was discharged without symptoms on day 44. CONCLUSIONS Although SSDH is rare, it is important for neurosurgeons and physicians to consider the possibility of a SSDH when lower limb pain or paresis occurs after procedures that will result in rapid intracranial pressure alterations such as drainage of an intracranial CSDH.
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Spontaneous Intracranial and Lumbar Subdural Hematoma Presenting as Vaginal Pain. J Emerg Med 2019; 56:e43-e46. [PMID: 30745198 DOI: 10.1016/j.jemermed.2018.12.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 12/11/2018] [Accepted: 12/24/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Spontaneous spinal and intracranial subdural hematomas are rarely reported, especially occurring simultaneously. Anticoagulation use has been associated with spontaneous hemorrhages. Prompt diagnosis is required to prevent permanent neurological sequelae. In this case report, we describe a spontaneous spinal and intracranial subdural hematoma in a woman taking warfarin and initially presenting with severe vaginal pain. CASE REPORT A 42-year-old woman who had a history of mechanical valve replacement and was therefore taking warfarin, came to an emergency department for relief of severe vaginal pain. Mild concurrent lumbar pain increased concern about spinal pathology, so magnetic resonance imaging of her spine was performed. It revealed a subdural hematoma extending from L1-S1 with arachnoiditis, which suggested intracranial pathology, though the patient had no complaint of a headache. Computed tomography of her brain demonstrated a large right subdural hemorrhage with midline shift. Subsequent imaging revealed no aneurysm or source of the intracranial bleeding. We concluded that the patient experienced spontaneous anticoagulation-related intracranial hemorrhage resulting in lumbar subdural hematoma and arachnoiditis with referred vaginal pain. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Pelvic, vaginal, or perineal pain may be the presenting symptom in patients with lower spinal pathology. It is important to consider causes other than gynecological ones in the differential diagnosis of these patients, as well as to be cognizant of the relationship between spinal and intracranial subdural hemorrhages. In patients with back pain or radiating lumbar pain, especially coupled with neurological effects, clinicians should consider spinal subdural hemorrhage and arachnoiditis to expedite imaging studies and treatment of these rare entities.
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Rajwani KM, Giamouriadis A, Minhas PS. Spinal subdural hematoma post foramen magnum decompression-rare complication in a patient with rhomboencephalosynapsis. JOURNAL OF SPINE SURGERY 2018; 3:719-722. [PMID: 29354754 DOI: 10.21037/jss.2017.11.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Spinal subdural hematoma (SSDH) as a complication of posterior fossa surgery is extremely rare and can have potentially serious consequences. We report a case of delayed extensive SSHD presenting as cauda equina syndrome (CES) following foramen magnum decompression and occipito-cervical (OC) fusion.
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Paisan GM, Buell TJ, Raper D, Asthagiri A. Lumbosacral Subdural Hematoma After Glioblastoma Multiforme Resection: Possible Radiographic Evidence for the Downward Migration of Intracranial Blood. World Neurosurg 2017; 108:993.e13-993.e17. [DOI: 10.1016/j.wneu.2017.08.189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 08/28/2017] [Accepted: 08/30/2017] [Indexed: 11/15/2022]
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Kanamaru H, Kanamaru K, Araki T, Hamada K. Simultaneous Spinal and Intracranial Chronic Subdural Hematoma Cured by Craniotomy and Laminectomy: A Video Case Report. Case Rep Neurol 2016; 8:72-7. [PMID: 27194987 PMCID: PMC4868945 DOI: 10.1159/000445709] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Simultaneous spinal and intracranial chronic subdural hematoma (CSDH) is a rare entity. A 67-year-old man visited our hospital due to headache after diving into a river 2 weeks before. Non-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) revealed bilateral intracranial CSDH. The bilateral CSDH was evacuated and his symptoms improved. Three days after craniotomy, he complained of sensory disturbance on his buttocks. Lumbar MRI showed a space-occupying lesion behind the thecal sac at L5. CT with myelography showed a subdural mass lesion; there was no communication with the subarachnoid space. Fourteen days after craniotomy, L5 laminectomy was performed and the dura mater was incised carefully. The video shows that a liquid hematoma similar to the intracranial CSDH flowed out, followed by cerebrospinal fluid. His symptoms improved after the operation and the hematoma did not recur. This is a rare condition of spinal CSDH demonstrated by neuroimaging and intraoperative video.
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Kim MS, Sim SY. Spinal Subdural Hematoma Associated with Intracranial Subdural Hematoma. J Korean Neurosurg Soc 2015; 58:397-400. [PMID: 26587198 PMCID: PMC4652005 DOI: 10.3340/jkns.2015.58.4.397] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 08/11/2014] [Accepted: 08/13/2014] [Indexed: 12/05/2022] Open
Abstract
The simultaneous occurrence of an intracranial and a spinal subdural hematoma (SDH) is rare. We describe a case of cranial SDH with a simultaneous spinal SDH. An 82-year-old woman visited the emergency room because of drowsiness and not being able to walk 6 weeks after falling down. A neurological examination showed a drowsy mentality. Brain computed tomography showed bilateral chronic SDH with an acute component. The patient underwent an emergency burr-hole trephination and hematoma removal. She exhibited good recovery after the operation. On the fourth postoperative day, she complained of low-back pain radiating to both lower limbs, and subjective weakness of the lower limbs. Spine magnetic resonance imaging revealed a thoracolumbosacral SDH. A follow-up spinal magnetic resonance imaging study that was performed 16 days later showed a significant decrease in the size of the spinal SDH. We discuss the pathogenesis of this simultaneous occurrence of spinal and cranial SDH.
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Affiliation(s)
- Myoung Soo Kim
- Department of Neurosurgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Sook Young Sim
- Department of Neurosurgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Liao CH, Chang FC, Hsu SP, Hung YC, Chen HH, Liang ML, Wong TT, Shih YH. Spinal subdural hematoma following posterior fossa surgery. FORMOSAN JOURNAL OF SURGERY 2013. [DOI: 10.1016/j.fjs.2013.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Amiri AR, Fouyas IP, Cro S, Casey ATH. Postoperative spinal epidural hematoma (SEH): incidence, risk factors, onset, and management. Spine J 2013; 13:134-40. [PMID: 23218510 DOI: 10.1016/j.spinee.2012.10.028] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Revised: 07/10/2012] [Accepted: 10/13/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spinal epidural hematoma (SEH) is a rare, yet potentially devastating complication of spinal surgery. There is limited evidence available regarding the risk factors and timing for development of symptomatic SEH after spinal surgery. PURPOSE To assess the incidence, risk factors, time of the onset, and effect of early evacuation of symptomatic SEH after spinal surgery. STUDY DESIGN Multicenter case control study. PATIENT SAMPLE All patients who underwent open spinal surgery between October 1, 1999, and September 30, 2006, at the National Hospital For Neurology and Neurosurgery (NHNN) and the Wellington Hospital (WH) were reviewed. OUTCOME MEASURES Frankel grade. METHODS Patients who developed SEH and underwent evacuation of the hematoma were identified. Two controls per case were selected. Each control had undergone a procedure with similar complexity, at the same section of the spine, at the same hospital, and under the same surgeon within 6 months of the initial operation. RESULTS A total of 4,568 open spinal operations were performed at NHNN and WH. After spinal surgery, 0.22% of patients developed symptomatic SEH. Alcohol greater than 10 units a week (p=.031), previous spinal surgery (p=.007), and multilevel procedures (p=.002) were shown to be risk factors. Initial symptoms of SEH presented after a median time of 2.7 hours (interquartile range [IQR], 1.1-126.1). Patients who had evacuation surgery within 6 hours of the onset of initial symptoms improved a median of 2 (IQR, 1.0-3.0) Frankel grades, and those who had surgery more than 6 hours after the onset of symptoms improved 1.0 (IQR, 0.0-1.5) Frankel grade, p=.379. CONCLUSIONS Symptomatic postoperative SEH is rare, occurring in 0.22% of cases. Alcohol consumption greater than 10 units a week, multilevel procedure, and previous spinal surgery were identified as risk factors for developing SEH. Spinal epidural hematoma often presents early in the postoperative period, highlighting the importance of close patient monitoring within the first 4 hours after surgery. This study suggests that earlier surgical intervention may result in greater neurological recovery.
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Affiliation(s)
- Amir R Amiri
- Spinal Injury Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom.
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Choudhary AK, Bradford RK, Dias MS, Moore GJ, Boal DKB. Spinal subdural hemorrhage in abusive head trauma: a retrospective study. Radiology 2011; 262:216-23. [PMID: 22069156 DOI: 10.1148/radiol.11102390] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare the relative incidence, distribution, and radiologic characteristics of spinal subdural hemorrhage after abusive head trauma versus that after accidental trauma in children. MATERIALS AND METHODS This study received prior approval from the Human Subjects Protection Office. Informed consent was waived. This study was HIPAA compliant. Two hundred fifty-two children aged 0-2 years treated for abusive head trauma at our institute between 1997 and 2009 were identified through retrospective chart review. A second group of 70 children aged 0-2 years treated at our institute for well-documented accidental trauma between 2003 and 2010 were also identified through retrospective chart review. All clinical data and cross-sectional imaging results, including computed tomographic and magnetic resonance imaging of the brain, spine, chest, abdomen, and pelvis, were reviewed for both of these groups. A Fisher exact test was performed to assess the statistical significance of the proportion of the spinal canal subdural hemorrhage in abusive head trauma versus that in accidental trauma. RESULTS In the abusive head trauma cohort, 67 (26.5%) of 252 children had evaluable spinal imaging results. Of these, 38 (56%) of 67 children had undergone thoracolumbar imaging, and 24 (63%) of 38 had thoracolumbar subdural hemorrhage. Spinal imaging was performed in this cohort 0.3-141 hours after injury (mean, 23 hours ± 27 [standard deviation]), with 65 (97%) of 67 cases having undergone imaging within 52 hours of injury. In the second cohort with accidental injury, only one (1%) of 70 children had spinal subdural hemorrhage at presentation; this patient had displaced occipital fracture. The comparison of incidences of spinal subdural hemorrhage in abusive head trauma versus those in accidental trauma was statistically significant (P < .001). CONCLUSION Spinal canal subdural hemorrhage was present in more than 60% of children with abusive head trauma who underwent thoracolumbar imaging in this series but was rare in those with accidental trauma.
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Affiliation(s)
- Arabinda Kumar Choudhary
- Department of Radiology, Penn State University College of Medicine, Milton S. Hershey Medical Center, 500 University Dr, Hershey, PA 17033, USA.
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Waldron JS, Oh MC, Chou D. Lumbar Subdural Hematoma From Intracranial Subarachnoid Hemorrhage Presenting With Bilateral Foot Drop: Case Report. Neurosurgery 2011; 68:E835-9; discussion E839. [DOI: 10.1227/neu.0b013e3182078099] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE:
We report a patient with lumbar subdural hematoma secondary to intracranial subarachnoid hemorrhage (SAH) presenting with bilateral foot drop and describe our management.
CLINICAL PRESENTATION:
A 37-year-old woman presented with grade 4 SAH and hydrocephalus requiring emergent external ventricular drainage. Angiography demonstrated a left vertebral artery dissection and pseudoaneurysm that was treated with embolization of the vertebral artery. Six days after admission, her neurologic examination significantly improved. She was awake, alert, following commands, and moving all her extremities normally except for bilateral foot drop. An MRI scan revealed a lumbar subdural hematoma with severe thecal sac compression at L4-S1. The patient was initially treated with expectant management followed by surgery after she demonstrated only modest improvement. Evacuation of the hematoma was undertaken by an L5-S1 laminectomy and drainage of the liquefied clot in the subdural, extra-arachnoid space. Postoperatively, the patient demonstrated improved strength in all muscle groups except for left lower extremity eversion.
CONCLUSION:
We present a case of subdural hematoma that caused bilateral foot drop. Neurologic improvement occured after evacuation of the hematoma.
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Affiliation(s)
- James S Waldron
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Michael C Oh
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Dean Chou
- Department of Neurological Surgery, University of California, San Francisco, California
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Spinal strokes. HANDBOOK OF CLINICAL NEUROLOGY 2008. [PMID: 18804675 DOI: 10.1016/s0072-9752(08)93034-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
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Morishige M, Abe T, Ishii K, Fujiki M, Kobayashi H, Karashima A, Yamashita M. Spontaneous chronic head and spinal subdural haematoma. Acta Neurochir (Wien) 2007; 149:1081-2; discussion 1082. [PMID: 17665089 DOI: 10.1007/s00701-007-1256-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Accepted: 07/06/2007] [Indexed: 11/28/2022]
Abstract
Spinal chronic subdural haematomas (SSDH) are extremely rare. We report a case of a SSDH combined with intracranial SDH. After tapping the SSDH in addition to the evacuation of SDH, the clinical symptoms dramatically improved. SSDH are considered to have an uncertain prognosis; however, good results can be obtained with an early diagnosis and prompt treatment.
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MESH Headings
- Headache/etiology
- Hematoma, Subdural, Chronic/diagnosis
- Hematoma, Subdural, Chronic/surgery
- Hematoma, Subdural, Intracranial/diagnosis
- Hematoma, Subdural, Intracranial/surgery
- Hematoma, Subdural, Spinal/diagnosis
- Hematoma, Subdural, Spinal/surgery
- Humans
- Low Back Pain/etiology
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Spinal Puncture
- Trephining
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Affiliation(s)
- M Morishige
- Department of Neurosurgery, Oita University School of Medicine, Oita, Japan
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Mursch K, Halatsch ME, Steinhoff BJ, Behnke-Mursch J. Lumbar subdural haematoma after temporomesial resection in epilepsy patients-report of two cases and review of the literature. Clin Neurol Neurosurg 2007; 109:442-5. [PMID: 17349739 DOI: 10.1016/j.clineuro.2007.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2006] [Revised: 01/30/2007] [Accepted: 02/02/2007] [Indexed: 11/23/2022]
Abstract
We present two cases of lumbar subdural haematoma, both occurring after an uneventful temporomesial focus resection in patients suffering from medically intractable epilepsy. Initial symptom was back pain and sciatica 4 days and 13 days postoperatively, but no neurological deficits were observed. The diagnosis was confirmed by MRI. No risk factor could be identified. The pain responded well to conservative treatment and the haematomas resolved without neurological sequelae. A review of the literature reveals that the characteristics of spinal subdural haematoma following craniotomy are very similar. Six out of 12 reported cases occurred in temporal epilepsy surgery. All had a benign course and did not require an operative procedure. Back pain after epilepsy surgery may be caused by an intraspinal haematoma and should be investigated by MRI.
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Affiliation(s)
- Kay Mursch
- Department of Neurosurgery, Zentralklinik, Bad Berka, Germany.
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Braun P, Nogués-Meléndez P, Montoliu Fornás G, Martínez Martínez JC, Marcos Naranjo E. [Spontaneous spinal subdural hematoma: MRI findings in two cases]. RADIOLOGIA 2007; 49:47-50. [PMID: 17397622 DOI: 10.1016/s0033-8338(07)73716-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Spontaneous spinal subdural hematoma is an uncommon finding. This report of two cases of spinal subdural hematoma (one hyperacute and one subacute) discusses the current theory of how it develops, the MRI findings, its differentiation from spinal epidural hematoma, and the value of MRI in monitoring patients undergoing conservative treatment. The most significant MRI findings in the hyperacute phase were isointense signal on T1-weighted sequences and hyperintense signal on T2-weighted sequences. Moreover, T2-weighted gradient-echo sequences showed a hypointense peripheral ring. In the subacute phase, a hyperintense signal was seen on T1-, T1-fat-suppression, and T2-weighted sequences.
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Affiliation(s)
- P Braun
- Departamento de Radiodiagnóstico, Hospital La Fe, Valencia, España.
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Lee TH, Su TM, Wang KW, Lee HL, Ho JT. Lumbosacral spinal subdural hematoma following burr hole craniotomy: Case report and literature review. Clin Neurol Neurosurg 2007; 109:282-6. [PMID: 17169484 DOI: 10.1016/j.clineuro.2006.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Revised: 08/18/2006] [Accepted: 11/14/2006] [Indexed: 10/23/2022]
Abstract
Spinal subdural hematoma is a rare complication of cranial surgery. This study reports a case of postcraniotomy lumbosacral spinal subdural hematoma in the absence of predisposing factors. A review of the literature is also presented.
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Affiliation(s)
- Tsung-Han Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Kim MS, Lee CH, Lee SJ, Rhee JJ. Spinal Subdural Hematoma Following Intracranial Aneurysm Surgery-Four Case Reports-. Neurol Med Chir (Tokyo) 2007; 47:22-5. [PMID: 17245010 DOI: 10.2176/nmc.47.22] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
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.
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Affiliation(s)
- Myoung Soo Kim
- Department of Neurosurgery, Seoul Paik Hospital, Inje University College of Medicine, Jung-Gu, Seoul, Korea.
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21
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Hicdonmez T, Kilincer C, Hamamcioglu MK, Cobanoglu S. Paraplegia due to spinal subdural hematoma as a complication of posterior fossa surgery: Case report and review of the literature. Clin Neurol Neurosurg 2006; 108:590-4. [PMID: 15890442 DOI: 10.1016/j.clineuro.2005.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2005] [Revised: 04/07/2005] [Accepted: 04/11/2005] [Indexed: 11/29/2022]
Abstract
Although blood contamination of cerebrospinal fluid (CSF) after an intracranial operation is possible, development of a symptomatic spinal hematoma after a posterior fossa surgery has never been reported. A 43-year-old woman underwent a posterior fossa tumor removal in the prone position with no intraoperative difficulty. On the second postoperative day, she complained of severe epigastric pain and developed a rapid onset of paraplegia with anesthesia below the thoracic 5 spinal level. The emergency cranial and spinal MRIs revealed a spinal extramedullary hemorrhage spreading to the whole spinal regions, just sparing the cauda equina area. There was a prominent localized hematoma formation surrounding and compressing the spinal cord at the upper thoracic levels, which was evacuated via an urgent laminectomy. The patient showed partial neurological recovery after the decompression. Development of the spinal hematoma was explained by the movement of blood from the tumor bed into the spinal canal under the effect of gravity, during or after the operation. A 30 degrees head elevation might facilitate the accumulation of blood. Localization of the hematoma formation may be caused by the fact that the upper thoracic levels constitute the apex of the kyphosis. We conclusively suggest that a spinal hematoma should be taken into consideration as a rare but potentially severe complication of a posterior fossa surgery. Meticulous hemostasis and isolation of the surgical area from the spinal spaces are essential. Overdrainage of CSF should be abandoned. Postoperatively, patients should be monitored for spinal findings as well as cranial signs.
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Affiliation(s)
- Tufan Hicdonmez
- Department of Neurosurgery, Trakya University, Faculty of Medicine, Edirne, Turkey.
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22
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Sari A, Sert B, Dinc H, Kuzeyli K. Subacute spinal subdural hematoma associated with intracranial subdural hematoma. J Neuroradiol 2006; 33:67-9. [PMID: 16528209 DOI: 10.1016/s0150-9861(06)77231-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We describe a subacute spinal subdural hematoma in a patient with psot-traumatic subacute intracranial subdural hematoma. CT and MRI demonstrated hematoma within the interhemispheric subdural space and at the lumbar posterior subdural space which extended from the L1 to the S2 level. The lesion showed high signal intensity on both T1 and T2 weighted images. Surgical decompression of the spinal subdural hematoma was performed. The symptoms completely resolved after surgery. Spinal subdural hematoma may be concomitant with or may occur after intracranial subdural hematoma. If a patient with intracranial subdural hematoma complains of low back pain and weakness in both legs; lumbosacral MR examination should be performed to exclude spinal subdural hematoma.
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MESH Headings
- Craniocerebral Trauma/complications
- Hematoma, Subdural, Intracranial/complications
- Hematoma, Subdural, Intracranial/diagnostic imaging
- Hematoma, Subdural, Intracranial/pathology
- Hematoma, Subdural, Spinal/diagnostic imaging
- Hematoma, Subdural, Spinal/etiology
- Hematoma, Subdural, Spinal/pathology
- Humans
- Male
- Middle Aged
- Radiography
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Affiliation(s)
- A Sari
- Department of Radiology, Karadeniz Technical University Faculty of Medicine, Farabi Hospital, Trabzon 61080, Turkey.
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23
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Hematoma espinal subdural espontáneo. RADIOLOGIA 2005. [DOI: 10.1016/s0033-8338(05)72851-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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24
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Indications et risques des techniques neuro-chirurgicales chez l’adulte présentant une épilepsie partielle pharmaco-résistante (radio-chirurgie comprise). Rev Neurol (Paris) 2004. [DOI: 10.1016/s0035-3787(04)71199-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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