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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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Porter ZR, Johnson MD, Horn PS, Ngwenya LB. Traumatic spinal subdural hematoma: An illustrative case and series review. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2019.100570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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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 HG, Kim TW, Park KH, Chi MP. Traumatic Spinal Subdural Hematoma with Intracranial Subdural Hematoma. Korean J Neurotrauma 2014; 10:146-8. [PMID: 27169053 PMCID: PMC4852623 DOI: 10.13004/kjnt.2014.10.2.146] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 10/10/2014] [Accepted: 10/12/2014] [Indexed: 11/17/2022] Open
Abstract
Traumatic spinal subdural hematoma associated with intracranial subdural hematoma is a rare condition. Herein, we report the case of a 62-year-old man with lower back pain, radiating pain, and numbness in both lower extremities, without motor weakness, for 2 weeks. Lumbar magnetic resonance imaging (MRI) revealed high signal intensity on T1-weighted image (WI), and low signal intensity on T2-WI from L2 to L5. Two weeks after conservative management, follow-up lumbar MRI did not show the hematoma and his symptoms were relieved and there was no neurological deficit; therefore, he was discharged. However, subsequently, intracranial subdural hematoma increased and upper extremity motor weakness appeared. This was treated surgically. If there is no neurological deficit, conservative treatment may be a good option. Follow-up evaluation for asymptomatic cranial subdural hematoma is necessary.
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Affiliation(s)
- Hyun Gon Kim
- Department of Neurosurgery, VHS Medical Center, Seoul, Korea
| | - Tae Wan Kim
- Department of Neurosurgery, VHS Medical Center, Seoul, Korea
| | - Kwan Ho Park
- Department of Neurosurgery, VHS Medical Center, Seoul, Korea
| | - Moon Pyo Chi
- Department of Neurosurgery, VHS Medical Center, Seoul, Korea
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Concurrent intracranial and spinal subdural hematoma in a teenage athlete: a case report of this rare entity. Case Rep Radiol 2014; 2014:143408. [PMID: 25349764 PMCID: PMC4198776 DOI: 10.1155/2014/143408] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 09/07/2014] [Indexed: 11/30/2022] Open
Abstract
A 15-year-old male high school football player presented with episodes of headache and complete body stiffness, especially in the arms, lower back, and thighs, immediately following a football game. This was accompanied by severe nausea and vomiting for several days. Viral meningitis was suspected by the primary clinician, and treatment with corticosteroids was initiated. Over the next several weeks, there was gradual symptom improvement and the patient returned to his baseline clinical status. The patient experienced a severe recurrence of the previous myriad of symptoms following a subsequent football game, without an obvious isolated traumatic episode. In addition, he experienced a new left sided headache, fatigue, and difficulty ambulating. He was admitted and an extensive workup was performed. CT and MRI of the head revealed concurrent intracranial and spinal subdural hematomas (SDH). Clinical workup did not reveal any evidence of coagulopathy or predisposing vascular lesions. Spinal SDH is an uncommon condition whose concurrence with intracranial SDH is an even greater clinical rarity. We suggest that our case represents an acute on chronic intracranial SDH with rebleeding, membrane rupture, and symptomatic redistribution of hematoma to the spinal subdural space.
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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.
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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
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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.
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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
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Perlepe V, Haenecour L, Duprez T, Omoumi P, Vande Berg BC, Lecouvet FE. Lumbar pain with intracranial origin. Acta Radiol 2013; 54:324-6. [PMID: 23436829 DOI: 10.1177/0284185112471794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 48-year-old woman presented low-back pain radiating to the lower right leg. Magnetic resonance imaging (MRI) of the lumbar spine revealed a L4-L5 subacute subdural hematoma (SDH). The patient had no general or local cause for this lumbar SDH, such as coagulation disorder, trauma, surgery, or lumbar puncture. She had a history of post-traumatic bilateral hemorrhagic contusions of the brain and intracranial SDH because of a fall occurring several months before the current problems. A downward migration of the cerebral SDH was found as only potential explanation of the lumbar SDH. The association between the intracranial and spinal hematomas is discussed.
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Affiliation(s)
- Vasiliki Perlepe
- Cliniques Universitaires Saint-Luc - Radiology, Brussels, Belgium
| | - Luc Haenecour
- Cliniques Universitaires Saint-Luc - Radiology, Brussels, Belgium
| | - Thierry Duprez
- Cliniques Universitaires Saint-Luc - Radiology, Brussels, Belgium
| | - Patrick Omoumi
- Cliniques Universitaires Saint-Luc - Radiology, Brussels, Belgium
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Lee KD, Sim HB, Lyo IU, Kwon SC, Park JB. Delayed onset of spinal subdural hematoma after vertebroplasty for compression fracture: a case report. KOREAN JOURNAL OF SPINE 2012; 9:285-8. [PMID: 25983834 PMCID: PMC4431021 DOI: 10.14245/kjs.2012.9.3.285] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 09/21/2012] [Accepted: 09/25/2012] [Indexed: 02/06/2023]
Abstract
Vertebroplasty (VP) is a well-known therapeutic modality used to treat pain associated with vertebral compression fractures. Major complications such as cord or root compression, epidural and subdural hematomas (SDH) and pulmonary emboli, occur in less than 1% of patients who undergo VP after compression fracture. Spinal SDH is an extremely rare complication that usually happens a few hours after the procedure. We report a case of spinal SDH that developed at two weeks after a successful VP. We also reviewed related literatures and discussed its possible pathogenesis.
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Affiliation(s)
- Keong Duk Lee
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hong Bo Sim
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - In Uk Lyo
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Soon Chan Kwon
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jun Bum Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Sudo H, Abumi K, Menjo Y, Ito M. Post-traumatic lumbar subdural hematoma. Spine J 2012; 12:714-5. [PMID: 22770986 DOI: 10.1016/j.spinee.2012.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 01/22/2012] [Accepted: 06/19/2012] [Indexed: 02/03/2023]
Affiliation(s)
- Hideki Sudo
- Department of Advanced Medicine for Spine and Spinal Cord Disorders, Hokkaido University Graduate School of Medicine, North-15 West-7, Kita-ku, Sapporo, Hokkaido, Japan
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11
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WAJIMA D, YOKOTA H, IDA Y, NAKASE H. Spinal Subdural Hematoma Associated With Traumatic Intracranial Interhemispheric Subdural Hematoma. Neurol Med Chir (Tokyo) 2012; 52:636-9. [DOI: 10.2176/nmc.52.636] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Yuki IDA
- Department of Neurosurgery, Nabari City Hospital
| | - Hiroyuki NAKASE
- Department of Neurosurgery, Nara Medical University School of Medicine
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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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Berhouma M, Al Dahak N, Messerer R, Al Rammah M, Vallee B. A rare, high cervical traumatic spinal subdural hematoma. J Clin Neurosci 2011; 18:569-74. [PMID: 21277780 DOI: 10.1016/j.jocn.2010.07.127] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 07/14/2010] [Accepted: 07/17/2010] [Indexed: 11/30/2022]
Abstract
Spinal subdural hematomas (SSDH) are rare lesions occurring in association with a wide variety of conditions, including anticoagulation, coagulation disorders, spinal anesthesia, lumbar puncture, spinal tumors and vascular malformations. SSDH resulting from trauma are the exception. We present a 62-year-old woman with a rare post-traumatic focal SSDH at C1 with bulbomedullary compression, treated successfully with surgery. A review of the literature revealed 26 patients with traumatic SSDH. The aim of this report is to describe the clinical presentation, imaging characteristics and management of traumatic SSDH. The controversial pathogenesis is also discussed.
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Affiliation(s)
- Moncef Berhouma
- Department of Neurosurgery B (Unit 501), Pierre Wertheimer Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel 69394, Lyon Cedex 03, France.
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