1
|
Andrea I, Federica N, Adolfo DL, Maurizio S. Holocordic Spinal Subdural Hematoma: A Challenging Management In Emergency. Literature Review. World Neurosurg 2022; 160:44-49. [PMID: 35066207 DOI: 10.1016/j.wneu.2022.01.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/12/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Iaquinandi Andrea
- Department of Neurosurgery, Policlinico "Tor Vergata", University of Rome ''Tor Vergata''. Viale Oxford 81, 00133 Rome, Italy.
| | - Novegno Federica
- Department of Neurosurgery, Policlinico "Tor Vergata", University of Rome ''Tor Vergata''. Viale Oxford 81, 00133 Rome, Italy
| | - De Luna Adolfo
- Department of Neurosurgery, Policlinico "Tor Vergata", University of Rome ''Tor Vergata''. Viale Oxford 81, 00133 Rome, Italy
| | - Salvati Maurizio
- Department of Neurosurgery, Policlinico "Tor Vergata", University of Rome ''Tor Vergata''. Viale Oxford 81, 00133 Rome, Italy
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
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.
Collapse
|
4
|
Oichi Y, Toda H, Yamagishi K, Tsujimoto Y. Multiple Spinal Chronic Subdural Hematomas Associated with Thoracic Hematomyelia: A Case Report and Literature Review. World Neurosurg 2019; 131:95-103. [PMID: 31394354 DOI: 10.1016/j.wneu.2019.07.209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/28/2019] [Accepted: 07/29/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic subdural hematoma (CSDH) is uncommon in the spine. Most spinal CSDHs occur as solitary lesions in the lumbosacral region. We report a rare case of multiple spinal CSDHs associated with hematomyelia. The diagnostic and therapeutic management of these complex spinal CSDHs is reviewed as well as the pertinent literature. CASE DESCRIPTION A 79-year-old woman on warfarin therapy presented with lower back pain and progressive lower extremity weakness that had developed in the previous 2 weeks. She subsequently developed paraplegia and urinary incontinence. Thoracolumbar magnetic resonance imaging showed a CSDH from T12-L3 compressing the cauda equina. Single-shot whole-spine magnetic resonance imaging showed another CSDH and hematomyelia at T2-3. She underwent L2-3 hemilaminectomy, which revealed a liquefied subdural hematoma. Delayed T2 laminectomy exposed an organized subdural hematoma and xanthochromic hematomyelia. After each surgery, the patient showed significant motor recovery. Finally, the patient could walk, and the urinary catheter was removed. CONCLUSIONS Spinal CSDH may occur in multiple regions and may be associated with hematomyelia. Whole-spine magnetic resonance imaging is useful to examine the entire spine for CSDH accurately and thoroughly. Comprehensive surgical exploration of all symptomatic hematomas may restore neurologic functions even with delayed surgery.
Collapse
MESH Headings
- Aged
- Female
- Hematoma, Subdural, Chronic/complications
- Hematoma, Subdural, Chronic/diagnostic imaging
- Hematoma, Subdural, Chronic/surgery
- Hematoma, Subdural, Spinal/complications
- Hematoma, Subdural, Spinal/diagnostic imaging
- Hematoma, Subdural, Spinal/surgery
- Humans
- Laminectomy
- Lumbar Vertebrae/diagnostic imaging
- Lumbar Vertebrae/surgery
- Magnetic Resonance Imaging
- Paraplegia/etiology
- Spinal Cord Vascular Diseases/diagnostic imaging
- Spinal Cord Vascular Diseases/etiology
- Thoracic Vertebrae/diagnostic imaging
- Thoracic Vertebrae/surgery
- Urinary Retention/etiology
Collapse
Affiliation(s)
- Yuki Oichi
- Department of Neurosurgery, Fukui Red Cross Hospital, Fukui, Japan
| | - Hiroki Toda
- Department of Neurosurgery, Fukui Red Cross Hospital, Fukui, Japan.
| | - Koji Yamagishi
- Department of Rehabilitation, Fukui Red Cross Hospital, Fukui, Japan
| | | |
Collapse
|
5
|
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.
Collapse
|
6
|
Wang Y, Zheng H, Ji Y, Lu Q, Li X, Jiang X. Idiopathic Spinal Subdural Hematoma: Case Report and Review of the Literature. World Neurosurg 2018; 116:378-382. [DOI: 10.1016/j.wneu.2018.05.155] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/20/2018] [Accepted: 05/22/2018] [Indexed: 12/29/2022]
|
7
|
Ichinose D, Tochigi S, Tanaka T, Suzuki T, Takei J, Hatano K, Kajiwara I, Maruyama F, Sakamoto H, Hasegawa Y, Tani S, Murayama Y. Concomitant Intracranial and Lumbar Chronic Subdural Hematoma Treated by Fluoroscopic Guided Lumbar Puncture: A Case Report and Literature Review. Neurol Med Chir (Tokyo) 2018; 58:178-184. [PMID: 29479039 PMCID: PMC5929916 DOI: 10.2176/nmc.cr.2017-0177] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
A 40-year-old man presented with a severe headache, lower back pain, and lower abdominal pain 1 month after a head injury caused by falling. Computed tomography (CT) of the head demonstrated bilateral chronic subdural hematoma (CSDH) with a significant amount in the left frontoparietal region. At the same time, magnetic resonance imaging (MRI) of the lumbar spine also revealed CSDH from L2 to S1 level. A simple drainage for the intracranial CSDH on the left side was performed. Postoperatively, the headache was improved; however, the lower back and abdominal pain persisted. Aspiration of the liquefied spinal subdural hematoma was performed by a lumbar puncture under fluoroscopic guidance. The clinical symptoms were dramatically improved postoperatively. Concomitant intracranial and spinal CSDH is considerably rare so only 23 cases including the present case have been reported in the literature so far. The etiology and therapeutic strategy were discussed with a review of the literature. Therapeutic strategy is not established for these two concomitant lesions. Conservative follow-up was chosen for 14 cases, resulting in a favorable clinical outcome. Although surgical evacuation of lumbosacral CSDH was performed in seven cases, an alteration of cerebrospinal fluid (CSF) pressure following spinal surgery should be reminded because of the intracranial lesion. Since CSDH is well liquefied in both intracranial and spinal lesion, a less invasive approach is recommended not only for an intracranial lesion but also for spinal lesion. Fluoroscopic-guided lumbar puncture for lumbosacral CSDH following burr hole surgery for intracranial CSDH could be a recommended strategy.
Collapse
Affiliation(s)
| | - Satoru Tochigi
- Department of Neurosurgery, Jikei University Kashiwa Hospital
| | | | - Tomoya Suzuki
- Department of Neurosurgery, Jikei University Kashiwa Hospital
| | - Jun Takei
- Department of Neurosurgery, Jikei University Kashiwa Hospital
| | - Keisuke Hatano
- Department of Neurosurgery, Jikei University Kashiwa Hospital
| | - Ikki Kajiwara
- Department of Neurosurgery, Jikei University Kashiwa Hospital
| | | | - Hiroki Sakamoto
- Department of Neurosurgery, Jikei University Kashiwa Hospital
| | - Yuzuru Hasegawa
- Department of Neurosurgery, Jikei University Kashiwa Hospital
| | - Satoshi Tani
- Department of Neurosurgery, Jikei University School of Medicine
| | - Yuichi Murayama
- Department of Neurosurgery, Jikei University School of Medicine
| |
Collapse
|
8
|
Concomitant Intracranial Chronic Subdural Hematoma and Spinal Subdural Hematoma: A Case Report and Literature Review. World Neurosurg 2016; 90:706.e1-706.e9. [DOI: 10.1016/j.wneu.2016.03.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 03/08/2016] [Accepted: 03/08/2016] [Indexed: 11/19/2022]
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Coexistence of Spontaneous Spinal and Undiagnosed Cranial Subdual Hematomas. J Craniofac Surg 2015; 26:e118-9. [DOI: 10.1097/scs.0000000000001343] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
11
|
Lin JC, Layman K. Spontaneous spinal subdural hematoma of intracranial origin presenting as back pain. J Emerg Med 2014; 47:552-6. [PMID: 25216539 DOI: 10.1016/j.jemermed.2014.06.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 05/16/2014] [Accepted: 06/30/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Spinal subdural hematoma (SDH) is an uncommon condition mainly associated with bleeding dyscrasias, use of anticoagulants, trauma, iatrogenic procedures, and vascular malformations. Prompt diagnosis and treatment are recommended to prevent progressive neurologic compromise. Spinal SDH concomitant with intracranial SDH is an even rarer entity, with few cases reported in the English literature. Here we present a case of spontaneous spinal SDH with intracranial SDH presenting as sacral back pain in a 70-year-old man. We also describe the potential mechanism, treatment, and prognosis of concomitant spinal and intracranial SDH. CASE REPORT We report an unusual case of spontaneous spinal SDH concomitant with intracranial SDH and discuss the epidemiology, clinical presentation, potential etiology, treatment, and prognosis of this disease. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Awareness of the association between spinal SDH and intracranial SDH can expedite appropriate imaging of both brain and spine, which can lead to a more complete diagnosis and require changes in patient management in the emergency setting.
Collapse
Affiliation(s)
- Judy C Lin
- Emergency Medicine Department, Medstar Georgetown University Hospital and Medstar Washington Hospital Center, Washington, District of Columbia
| | - Kerri Layman
- Emergency Medicine Department, Medstar Georgetown University Hospital and Medstar Washington Hospital Center, Washington, District of Columbia
| |
Collapse
|
12
|
Kokubo R, Kim K, Mishina M, Isu T, Kobayashi S, Yoshida D, Morita A. Prospective assessment of concomitant lumbar and chronic subdural hematoma: is migration from the intracranial space involved in their manifestation? J Neurosurg Spine 2014; 20:157-63. [DOI: 10.3171/2013.10.spine13346] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Spinal subdural hematomas (SDHs) are rare and some are concomitant with intracranial SDH. Their pathogenesis and etiology remain to be elucidated although their migration from the intracranial space has been suggested. The authors postulated that if migration plays a major role, patients with intracranial SDH may harbor asymptomatic lumbar SDH. The authors performed a prospective study on the incidence of spinal SDH in patients with intracranial SDH to determine whether migration is a key factor in their concomitance.
Methods
The authors evaluated lumbar MR images obtained in 168 patients (125 males, 43 females, mean age 75.6 years) with intracranial chronic SDH to identify cases of concomitant lumbar SDH. In all cases, the lumbar MRI studies were performed within the 1st week after surgical irrigation of the intracranial SDH.
Results
Of the 168 patients, 2 (1.2%) harbored a concomitant lumbar SDH; both had a history of trauma to both the head and the hip and/or lumbar area. One was an 83-year-old man with prostate cancer and myelodysplastic syndrome who suffered trauma to his head and lumbar area in a fall from his bed. The other was a 70-year-old man who had hit his head and lumbar area in a fall. Neither patient manifested neurological deficits and their hematomas disappeared under observation. None of the patients with concomitant lumbar SDH had sustained head trauma only, indicating that trauma to the hip or lumbar region is significantly related to the concomitance of SDH (p < 0.05).
Conclusions
As the incidence of concomitant lumbar and intracranial chronic SDH is rare and both patients in this study had sustained a direct impact to the head and hips, the authors suggest that the major mechanism underlying their concomitant SDH was double trauma. Another possible explanation is hemorrhagic diathesis and low CSF syndrome.
Collapse
Affiliation(s)
- Rinko Kokubo
- 1Department of Neurosurgery, Nippon Medical School Chiba Hokuso Hospital, Chiba
| | - Kyongsong Kim
- 1Department of Neurosurgery, Nippon Medical School Chiba Hokuso Hospital, Chiba
| | - Masahiro Mishina
- 2Department of Neurological Science, Graduate School of Medicine, and
| | - Toyohiko Isu
- 3Department of Neurosurgery, Kushiro Rosai Hospital, Hokkaido, Japan
| | - Shiro Kobayashi
- 1Department of Neurosurgery, Nippon Medical School Chiba Hokuso Hospital, Chiba
| | - Daizo Yoshida
- 4Department of Neurosurgery, Nippon Medical School, Tokyo; and
| | - Akio Morita
- 4Department of Neurosurgery, Nippon Medical School, Tokyo; and
| |
Collapse
|