1
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Liu J, McHugh F, Li Y. Spinal subdural haemorrhage secondary to strenuous exercise and warfarin, complicated by acute ischaemic stroke. BMJ Case Rep 2024; 17:e258729. [PMID: 38442981 PMCID: PMC10916092 DOI: 10.1136/bcr-2023-258729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
Spinal subdural haemorrhage or haematoma (SSDH) is a rare condition that is often overlooked and missed on initial presentation due to its non-specific features that may mimic other more common pathologies. It is associated with high morbidity and mortality rates, with few evidence-based management principles, particularly during the subacute stages of recovery. In this report, we detail a case of SSDH associated with exercise and anticoagulation therapy, which was complicated by acute ischaemic stroke. SSDH should be suspected in cases of acute back pain without a clear alternative cause, particularly in coagulopathic individuals. Following treatment, early recommencement of anticoagulation therapy may be justified in certain cases where indicated, after careful consideration of the affected individual's risk profile.
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Affiliation(s)
- James Liu
- Neurosurgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Frances McHugh
- Neurosurgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Yingda Li
- Neurosurgery, Westmead Hospital, Westmead, New South Wales, Australia
- The University of Sydney School of Medicine, Sydney, New South Wales, Australia
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2
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Kaushik RM, Kumar R, Kaushik M, Saini M, Kaushik R. Spontaneous spinal intradural hemorrhage in dengue fever: a case report. J Med Case Rep 2022; 16:213. [PMID: 35644613 PMCID: PMC9150361 DOI: 10.1186/s13256-022-03451-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/07/2022] [Indexed: 11/26/2022] Open
Abstract
Background Spontaneous spinal cord hemorrhage is extremely rare in dengue fever. We report a case of spontaneous spinal intradural hemorrhage in dengue fever associated with severe thrombocytopenia. Case presentation A 48-year-old Indian woman presented with fever and body aches followed by acute onset of paraplegia with bladder and bowel dysfunction and loss of sensations below the level of the umbilicus. She had severe thrombocytopenia and positive dengue serology. Magnetic resonance imaging of the spine showed compression of the spinal cord due to intradural hematoma at the D7–D8 vertebral level. The patient received symptomatic treatment for dengue fever and steroids. Emergency D7–D8 laminectomy with excision of the clot and dural repair was done after stabilizing the platelet count with multiple platelet transfusions. The constitutional symptoms responded well to the treatment. There was good improvement in sensory symptoms but negligible improvement in paraplegia with a change in muscle power from grade 0/5 to grade 1/5 in the postoperative period. The patient was discharged from the hospital in a stable condition, but paraplegia showed little improvement during follow-up of 1 year. Conclusions Spontaneous spinal cord hemorrhage can present as acute paraplegia in dengue fever. Failure to recognize this complication can delay initiating appropriate treatment with permanent loss of neurologic function.
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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
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4
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Post-traumatic subdural spinal hematomas: Two case reports and systematic review of the literature. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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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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Li X, Yang G, Wen Z, Lou X, Lin X. Surgical treatment of progressive cauda equina compression caused by spontaneous spinal subdural hematoma: A case report. Medicine (Baltimore) 2019; 98:e14598. [PMID: 30896615 PMCID: PMC6708805 DOI: 10.1097/md.0000000000014598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Spontaneous spinal subdural hematoma (SSDH) without an underlying pathology is a very rare condition. The treatment protocol for SSDH is early diagnosis and treatment before irreversible damage to neural tissue. However, there is no agreement on the etiopathogenesis, as well as the need for surgery to treat spontaneous SSDH. Here, we report a rare case of spontaneous SSDH with progressive deterioration and symptoms of cauda equina syndrome after ineffective conservative treatment. PATIENT'S CONCERN A 38-year-old male patient presented with sudden lower back and bilateral leg pain. DIAGNOSIS A magnetic resonance imaging (MRI) scan on the third day after the onset of symptoms revealed a subdural hematoma from L1 to S1, presenting as hyperintensities on T1 weighted sequences and hypointensities to isointensities on T2 weighted sequences. INTERVENTION Laminectomy and subdural evacuation were performed immediately. OUTCOMES An abnormal ligamentum flavum was observed intraoperatively. A histological examination revealed extravasation of blood in the degenerated ligamentum flavum. Postoperatively, the lower limb pain improved immediately. At the 6-month follow-up, the pain and numbness of the lower limb disappeared, and the muscle strength of both legs recovered completely with normal gait. LESSONS Spontaneous SSDH with ligamentum flavum hematoma was caused by a sudden increase of intravenous pressure, resulting from a marked surge in the intra-abdominal or intrathoracic pressure. Consecutive MRI scans provided valuable information, leading to a diagnosis of spontaneous SSDH. The treatment protocol for spontaneous SSDH should be determined based on the location and stage of the hematoma, as well as the subject's neurological status.
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Affiliation(s)
- Xigong Li
- Department of Orthopedic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Ge Yang
- Department of Orthopedic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
- Department of Orthopedics, Hunan Children's Hospital, The Pediatric Academy of University of South China, Hunan, China
| | - Zhiqiang Wen
- Department of Orthopedic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Xianfeng Lou
- Department of Orthopedic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Xiangjin Lin
- Department of Orthopedic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
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Maheshwari V, Kumar S, Kumar A, Kumar A. Spontaneous Subdural Hematoma of Dorsal Spine Secondary to Dengue Fever: A Rare Case Report with Review of Literature. Asian J Neurosurg 2019; 14:550-552. [PMID: 31143280 PMCID: PMC6516024 DOI: 10.4103/ajns.ajns_228_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A 54-year-old female patient had a sudden onset of febrile illness following which she developed low backache and sudden onset paraplegia with urinary retention. Her hemogram, biochemistry, and coagulation profile was within normal limits. Her dengue serology was positive for IgG antibodies but negative for NS1 Ag. Magnetic resonance imaging of dorsolumbar spine revealed extensive subdural bleed from D6–D12 with cord compression. She underwent emergency laminectomy D6–D12 along with complete evacuation of hematoma. There was complete recovery of sensations in the immediate postoperative period though her motor weakness showed only marginal improvement.
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Affiliation(s)
| | - Sanjay Kumar
- Department of Neurosurgery, AFMC, Pune, Maharashtra, India
| | - Arun Kumar
- Department of Neurosurgery, AFMC, Pune, Maharashtra, India
| | - Ashok Kumar
- Department of Neurosurgery, AFMC, Pune, Maharashtra, India
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8
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Kita K, Sakai T, Yamashita K, Nagamachi A, Sairyo K. Spontaneous lumbar spinal subdural hematoma: a case report. Br J Neurosurg 2017; 33:264-268. [DOI: 10.1080/02688697.2017.1327021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kenichiro Kita
- The University of Tokushima Graduate School, Department of Orthopedics, Tokushima, Japan
| | - Toshinori Sakai
- The University of Tokushima Graduate School, Department of Orthopedics, Tokushima, Japan
| | - Kazuta Yamashita
- The University of Tokushima Graduate School, Department of Orthopedics, Tokushima, Japan
| | - Akihiro Nagamachi
- The University of Tokushima Graduate School, Department of Orthopedics, Tokushima, Japan
| | - Koichi Sairyo
- The University of Tokushima Graduate School, Department of Orthopedics, Tokushima, Japan
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Protzman NM, Kapun J, Wagener C. Thoracic spinal subdural hematoma complicating anterior cervical discectomy and fusion: case report. J Neurosurg Spine 2016; 24:295-299. [DOI: 10.3171/2015.5.spine141191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A spinal subdural hematoma is a rare clinical entity with considerable consequences without prompt diagnosis and treatment. Throughout the literature, there are limited accounts of spinal subdural hematoma formation following spinal surgery. This report is the first to describe the formation of a spinal subdural hematoma in the thoracic spine following surgery at the cervical level. A 53-year-old woman developed significant paraparesis several hours after anterior cervical discectomy and fusion of C5–6. Expeditious return to operating room for anterior cervical revision decompression was performed, and the epidural hematoma was evacuated without difficulty. Postoperative imaging demonstrated a subdural hematoma confined to the thoracic level, and the patient was returned to the operating room for a third surgical procedure. Decompression of T1–3, with evacuation of the subdural hematoma was performed. Postprocedure, the patient’s sensory and motor deficits were restored, and, with rehabilitation, the patient gained functional mobility. Spinal subdural hematomas should be considered as a rare but potential complication of cervical discectomy and fusion. With early diagnosis and treatment, favorable outcomes may be achieved.
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Affiliation(s)
| | - Jennifer Kapun
- 2Orthopedics, Coordinated Health, Bethlehem, Pennsylvania
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Oh JH, Jwa SJ, Yang TK, Lee CS, Oh K, Kang JH. Intracranial Vasospasm without Intracranial Hemorrhage due to Acute Spontaneous Spinal Subdural Hematoma. Exp Neurobiol 2015; 24:366-70. [PMID: 26713084 PMCID: PMC4688336 DOI: 10.5607/en.2015.24.4.366] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 11/15/2015] [Accepted: 11/24/2015] [Indexed: 11/19/2022] Open
Abstract
Spontaneous spinal subdural hematoma (SDH) is very rare. Furthermore, intracranial vasospasm (ICVS) associated with spinal hemorrhage has been very rarely reported. We present an ICVS case without intracranial hemorrhage following SDH. A 41-year-old woman was admitted to our hospital with a complaint of severe headache. Multiple intracranial vasospasms were noted on a brain CT angiogram and transfemoral cerebral angiography. However, intracranial hemorrhage was not revealed by brain MRI or CT. On day 3 after admission, weakness of both legs and urinary incontinence developed. Spine MRI showed C7~T6 spinal cord compression due to hyperacute stage of SDH. After hematoma evacuation, her symptoms gradually improved. We suggest that spinal cord evaluation should be considered in patients with headache who have ICVS, although intracranial hemorrhage would not be visible in brain images.
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Affiliation(s)
- Jung-Hwan Oh
- Department of Neurology, Jeju National University Hospital, Jeju 63241, Korea
| | - Seung-Joo Jwa
- Department of Neurology, Jeju National University Hospital, Jeju 63241, Korea
| | - Tae Ki Yang
- Department of Neurosurgery, Jeju National University Hospital, Jeju 63241, Korea
| | - Chang Sub Lee
- Department of Neurosurgery, Jeju National University Hospital, Jeju 63241, Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Medical Center, Seoul 02841, Korea
| | - Ji-Hoon Kang
- Department of Neurology, Jeju National University Hospital, Jeju 63241, Korea
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11
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Abbas MS, Asker OA. Significantly prolonged spinal anesthesia with the addition of dexamethasone: a case report. J Clin Anesth 2015; 27:524-6. [PMID: 26142073 DOI: 10.1016/j.jclinane.2015.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 04/07/2015] [Accepted: 05/27/2015] [Indexed: 10/23/2022]
Abstract
The purpose of the study is to highlight that prolonged blocks with spinal anesthesia are not usually due to neurologic defects. Consent for data publication was obtained. A 35-year-old female patient with right upper tibial chondrosarcoma was planned to undergo excision and reconstruction with a free vascularized fibular graft. The patient had no significant medical history. We gave spinal anesthesia, which is to be continued with general anesthesia after regression of the sensory level. After 3 hours, we evaluated the patient for the second time to find sensory block at T10 level. It was decided to carry out these evaluations hourly and wait for general anesthesia. Ten hours after the spinal anesthesia, the sensory block was still at T10 level. After 13 hours, the surgical procedure was finished, and the sensory block was still at T10 level and the motor block according to the Bromage scale remained at grade 4. A computed tomography was performed and did not reveal signs of spinal compression, spinal canal stenosis, or other anomalies (magnetic resonance imaging was unavailable). A complete motor and sensory recovery from the spinal block was observed 20 hours after spinal anesthesia. We present a case of major microscopic surgery done over 13 hours with a single shot of spinal anesthesia in a 35-year-old female patient. Complete recovery of sensory and motor blocks has been after 20 hours. We also review other cases of unusually prolonged spinal blocks and the possible differential diagnosis for that.
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Affiliation(s)
- Mostafa Samy Abbas
- Anesthesia and Intensive Care Department, Assiut University Hospital, Faculty of Medicine, Assiut University, Egypt.
| | - Omnia Ahmed Asker
- Anesthesia and Intensive Care Department, Assiut University Hospital, Faculty of Medicine, Assiut University, Egypt.
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12
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Goyal LD, Kaur H, Singh A. Cauda equina syndrome after repeated spinal attempts: A case report and review of the literature. Saudi J Anaesth 2015; 9:214-6. [PMID: 25829916 PMCID: PMC4374233 DOI: 10.4103/1658-354x.152892] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Spinal and epidural blocks are widely used for cesarean section. Spinal hematoma causing cauda equina syndrome is a rare complication after spinal anesthesia (SA), but can lead to severe neurological deficit. It is usually associated with difficult SA and requires surgical decompression in most of the cases.
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Affiliation(s)
- Lajya Devi Goyal
- Department of Obstetrics and Gynaecology, GGS Medical College and Hospital, Faridkot, Punjab, India
| | - Haramritpal Kaur
- Department of Anaesthesia, GGS Medical College and Hospital, Faridkot, Punjab, India
| | - Amandeep Singh
- Department of Surgery, GGS Medical College and Hospital, Faridkot, Punjab, India
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14
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Acute spinal subdural hematoma after vigorous back massage: a case report and review of literature. Spine (Phila Pa 1976) 2014; 39:E1545-8. [PMID: 25271505 DOI: 10.1097/brs.0000000000000629] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A case report and review of literature. OBJECTIVE We report on a patient with traumatic spinal subdural hematoma after vigorous back massage while on vacation. SUMMARY OF BACKGROUND DATA Traumatic spinal subdural hematoma is extremely rare, and to our knowledge, this is the first case reported after violent back massage. We emphasize a high index of suspicion for early recognition and treatment for a good neurological recovery. METHODS A 41-year-old male was brought to our hospital with severe back pain, motor and sensory impairments of the bilateral lower extremities, and urinary dysfunction after vigorous back massage. Magnetic resonance images revealed an acute spinal subdural hematoma in the thoracolumbar region. After careful monitoring of his neurological status, the patient was successfully managed with conservative treatment. RESULTS After 2 weeks of hospitalization, complete motor power recovery was achieved with only minor sensory deficit. At a follow-up of more than 12 months, the patient has no residual neurological deficits. CONCLUSION Spinal subdural hematoma secondary to physical trauma is quite rare. This case brings new information that traumatic spinal subdural hematoma can be caused by violent massage. LEVEL OF EVIDENCE N/A.
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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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Jun HS, Oh JK, Park YS, Song JH. Spinal Subdural Hematoma Following Meningioma Removal Operation. KOREAN JOURNAL OF SPINE 2014; 11:12-4. [PMID: 24891866 PMCID: PMC4040635 DOI: 10.14245/kjs.2014.11.1.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 03/03/2014] [Accepted: 03/19/2014] [Indexed: 12/02/2022]
Abstract
Although blood contamination of cerebrospinal fluid (CSF) after an intracranial operation can occur, the development of a symptomatic spinal hematoma after craniotomy has been anecdotally reported and it is uncommon reported after a supratentorial meningioma removal operation. We report a case of spinal subdural hematoma following a supratentorial meningioma removal operation and discuss the mechanism of spinal subdural hematoma (SSDH) development. A 54-year-old woman presented with lumbago and radicular pain on both legs 4 days after a right parietooccipital craniotomy for meningioma removal. Only the straight leg raising sign was positive on neurologic examination but the magnetic resonance imaging (MRI) demonstrated a lumbosacral spinal subdural hematoma. The patient received serial lumbar tapping, after which her symptoms showed improvement.
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Affiliation(s)
- Hyo Sub Jun
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University School of Medicine, Anyang, Korea
| | - Jae Keun Oh
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University School of Medicine, Anyang, Korea
| | - Young Seok Park
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University School of Medicine, Anyang, Korea
| | - Joon Ho Song
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University School of Medicine, Anyang, Korea
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17
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Ji GY, Oh CH, Chung D, Shin DA. Spinal subdural hematoma following cranial subdural hematoma : a case report with a literature review. J Korean Neurosurg Soc 2013; 54:515-7. [PMID: 24527196 PMCID: PMC3921281 DOI: 10.3340/jkns.2013.54.6.515] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 09/25/2013] [Accepted: 12/12/2013] [Indexed: 11/27/2022] Open
Abstract
Coexistence of cranial and spinal subdural hematomas is rare and only a few cases have been reported in the literature. Herein, we report a case of cranial and spinal subdural hematomas after previous head trauma. As the pathogenesis of simultaneous intracranial and spinal subdural hematoma yet remains unclear, we developed an alternative theory to those proposed in the literature for their coexistence, the migration of blood through the subdural space.
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Affiliation(s)
- Gyu Yeul Ji
- Department of Neurosurgery, Guro Teun Teun Hospital, Seoul, Korea. ; Department of Neurosurgery, College of Medicine, Yonsei University, Seoul, Korea
| | - Chang Hyun Oh
- Department of Neurosurgery, Guro Teun Teun Hospital, Seoul, Korea
| | - Daeyeong Chung
- Department of Neurosurgery, Daegu Teun Teun Hospital, Seoul, Korea
| | - Dong Ah Shin
- Department of Neurosurgery, College of Medicine, Yonsei University, Seoul, Korea
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18
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Balik V, Kolembus P, Svajdler M, Sulla I, Vaverka M, Hrabalek L. A case report of rapid spontaneous redistribution of acute supratentorial subdural hematoma to the entire spinal subdural space presenting as a Pourfour du Petit syndrome and review of the literature. Clin Neurol Neurosurg 2012; 115:849-52. [PMID: 23000183 DOI: 10.1016/j.clineuro.2012.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 07/23/2012] [Accepted: 09/03/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This report illustrates the rare rapid spontaneous redistribution of an acute intracranial supratentorial subdural hematoma (AISSDH) to the entire spinal subdural space (SSS). The study is also unique in that the spinal subdural hematoma (SSH) manifested by the extremely rare Pourfour du Petit Syndrome (PPS). METHODS A 66-year-old man sustained blunt head trauma. On admission to the regional hospital, he scored 6 on GCS and his pupils were of equal size reacting to light. Initial computed tomography (CT) scan showed a unilateral AISSDH. The patient was referred to our department and arrived 16 h following the accident, at which time a repeat CT scan revealed almost complete resolution of the AISSDH without clinical improvement. On the 9th postinjury day transient anisocoria and tachycardia without spinal symptomatology developed. Since neither neurological examination nor follow-up CT scans showed intracranial pathology explaining the anisocoria, the patient was treated further conservatively. During the next 3 days circulatory instability developed and the patient succumbed to primary traumatic injury. Autopsy revealed a SSH occupying the entire SSS. CONCLUSION This case calls attention to the unique combination of the displacement of an AISSDH to the SSS and the presentation of this clinical entity by the PPS.
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Affiliation(s)
- Vladimir Balik
- Department of Neurosurgery, Faculty Hospital Olomouc, I.P. Pavlova 6, 775 20 Olomouc, Czech Republic.
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Gakhar H, Bommireddy R, Klezl Z, Calthorpe D. Spinal subdural hematoma as a complication of spinal surgery: can it happen without dural tear? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 22 Suppl 3:S346-9. [PMID: 22810702 DOI: 10.1007/s00586-012-2427-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 06/17/2012] [Accepted: 06/30/2012] [Indexed: 12/13/2022]
Abstract
Post spinal surgery subdural hematoma is a rare entity. This is a report of a case of acute post-operative spinal subdural hematoma, without any dural injury. The case was managed expectantly and went on to complete resolution of the hematoma and full clinical recovery.
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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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23
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Nagashima H, Tanida A, Hayashi I, Tanishima S, Nanjo Y, Dokai T, Teshima R. Spinal subdural haematoma concurrent with cranial subdural haematoma: Report of two cases and review of literature. Br J Neurosurg 2010; 24:537-41. [DOI: 10.3109/02688691003656119] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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KIM K, KATSUNO M, ISU T, MISHINA M, YOSHIDA D, KOBAYASHI S, TERAMOTO A. Concomitant Cranial and Lumbar Subdural Hematomas -Case Report-. Neurol Med Chir (Tokyo) 2010; 50:402-4. [DOI: 10.2176/nmc.50.402] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kyongsong KIM
- Department of Neurosurgery, Chiba Hokusoh Hospital, Nippon Medical School
| | | | - Toyohiko ISU
- Department of Neurosurgery, Kushiro Rosai Hospital
| | - Masahiro MISHINA
- Department of Neurosurgery, Chiba Hokusoh Hospital, Nippon Medical School
| | | | - Shiro KOBAYASHI
- Department of Neurosurgery, Chiba Hokusoh Hospital, Nippon Medical School
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Traumatic Subacute Spinal Subdural Hematoma Successfully Treated With Lumbar Drainage. ACTA ACUST UNITED AC 2009; 22:73-6. [DOI: 10.1097/bsd.0b013e31816d6546] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Cincu R, de Asis Lorente F, Rivero D, Eiras J, Ara JR. Spontaneous subdural hematoma of the thoracolumbar region with massive recurrent bleed. Indian J Orthop 2009; 43:412-5. [PMID: 19838395 PMCID: PMC2762564 DOI: 10.4103/0019-5413.49383] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Spinal subdural hematoma is a rare disorder and can be caused by abnormalities of coagulation, blood dyscrasias, lumbar puncture, trauma, underlying neoplasm, and arteriovenous malformation. We discuss an unusual case of an elderly woman who presented with spontaneous spinal subdural hematoma and developed massive rebleeding on the third day following initial evacuation of hematoma. This case illustrates that a patient with routine normal coagulation profile and adequate hemostasis can still harbor platelet dysfunction (in present case due to polycythemia) and later on can manifest as rebleeding and neurological deterioration.
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Affiliation(s)
- Rafael Cincu
- Department of Neurosurgery, Miguel Servet University Hospital, Zaragoza, Spain,Address for correspondence: Dr. Rafael Cincu, Department of Neurosurgery, Miguel Servet University Hospital, Zaragoza, Spain. E-mail:
| | | | - David Rivero
- Department of Neurosurgery, Miguel Servet University Hospital, Zaragoza, Spain
| | - José Eiras
- Department of Neurosurgery, Miguel Servet University Hospital, Zaragoza, Spain
| | - José Ramón Ara
- Department of Neurology, Miguel Servet University Hospital, Zaragoza, Spain
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27
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Al B, Yildirim C, Zengin S, Genc S, Erkutlu I, Mete A. Acute spontaneous spinal subdural haematoma presenting as paraplegia and complete recovery with non-operative treatment. BMJ Case Rep 2009; 2009:bcr02.2009.1599. [PMID: 22065983 DOI: 10.1136/bcr.02.2009.1599] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Spontaneous spinal subdural haematoma (SSDH) with no underlying pathology is a very rare condition. Only 20 cases have been previously reported. It can be caused by abnormalities of coagulation, blood dyscrasia, or trauma, underlying neoplasm, and arteriovenous malformation. It occurs most commonly in the thoracic spine and presents with sudden back pain radiating to the arms, legs or trunk, and varying degrees of motor, sensory, and autonomic disturbances. Although the main approach to management is surgical decompression, conservative management is used as well. We report the case of a 57-year-old man who presented with sudden severe low back pain followed by rapid onset of complete paraplegia. Magnetic resonance imaging (MRI) revealed an anterior subdural haematoma from T9 to L1 with cord compression. Corticosteroid treatment was administered. The patient showed substantial clinical improvement after 7 days of bed rest and an intense rehabilitation programme. An MRI scan and a computed tomography angiogram did not reveal any underlying pathology to account for the subdural haematoma.
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Affiliation(s)
- Behçet Al
- Gaziantep University Hospital, Emergency Department, Medicine Faculty of Gaziantep University, Gaziantep, 27100, Turkey
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28
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Greiner-Perth R, Mohsen Allam Y, Silbermann J, Gahr R. Traumatic subdural hematoma of the thoraco-lumbar junction of spinal cord. ACTA ACUST UNITED AC 2007; 20:239-41. [PMID: 17473646 DOI: 10.1097/bsd.0b013e31802c2ff6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Spinal subdural hematoma (SSDH) is an exceedingly uncommon and potentially neurologically devastating condition. Recognition of blood products in magnetic resonance imaging is a very important clue for the diagnosis of SSDH. It is generally agreed that prompt surgical evacuation should be performed before irreversible damage to the spinal cord occurs. However, conservative treatment still plays a role in the management of SSDH. OBJECTIVES To describe the clinical presentation, characteristic MRI findings, and treatment of traumatic SSDH. METHODS A case of traumatic SSDH at the thoraco-lumbar junction. RESULTS Magnetic resonance imaging findings of high signal intensity lesion in both T1 and T2 sequences suggest the possibility of subdural hematoma although it may be mistaken for tumorlike cystic lesion of the cord. Although there is a place for conservative treatment of subdural hematoma, we believe that rapid surgical drainage of the subdural hematoma will be associated with the best prognosis especially in the cervical, thoracic, and thoraco-lumbar junctions of the spinal cord. CONCLUSIONS Rapid surgical drainage of traumatic SSDH affecting the thoraco-lumbar junction of the cord will be associated in most of the cases with rapid neurologic recovery.
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Affiliation(s)
- Ralph Greiner-Perth
- Department of Spine surgery, Orthopedic Surgery and Neurosurgery, SRH, Wald Klinikum Gera GmbH, Gera, Germany
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29
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Cronin CG, Lohan DG, Swords R, Murray M, Murphy JM, Roche C. Sacral insufficiency fracture complicated by epidural haematoma and cauda equina syndrome in a patient with multiple myeloma. Emerg Radiol 2007; 14:425-30. [PMID: 17570003 DOI: 10.1007/s10140-007-0623-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Accepted: 04/23/2007] [Indexed: 10/23/2022]
Abstract
We report the case of a patient with multiple myeloma (MM) and extensive lytic bone disease who presented with a short history of back pain and leg weakness. Magnetic resonance imaging (MRI) of the lumbar spine revealed a sacral insufficiency fracture complicated by an epidural haematoma. Bleeding tendency in this case can be accounted for by platelet function defects, often described in plasma cell disorders in the absence of obvious coagulation abnormalities. Surgical intervention was contraindicated as a result of poor overall patient performance status (poor surgical candidate due to extensive myelomatous bone disease, previous vertebral compression fractures requiring orthopaedic stabilisation, and requiring opiate analgesia for bone pain) and management was conservative. Patients presenting with back pain and documented bone disease in the setting of myeloma should be managed with a high index of clinical suspicion and considered for urgent MR imaging to avoid missing this serious and potentially reversible complication. We report the undescribed causative association between sacral insufficiency fracture and lumbo-sacral epidural haematoma. We illustrate the MRI signal and contrast enhancement pattern of an acute presentation of epidural haematoma.
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Affiliation(s)
- Carmel G Cronin
- Department of Radiology, University College Hospital, Galway, Ireland.
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Jang WY, Lee JK, Moon KS, Kwak HJ, Joo SP, Kim IY, Kim JH, Kim SH. Traumatic acute spinal subarachnoid hematoma. J Clin Neurosci 2006; 14:71-3. [PMID: 17092720 DOI: 10.1016/j.jocn.2005.12.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2005] [Accepted: 12/14/2005] [Indexed: 11/28/2022]
Abstract
This report describes a 66-year-old man who presented with progressive paraparesis after a fall. Magnetic resonance imaging showed an acute spinal hematoma at T11-12 with spinal cord compression. The patient underwent an emergency left T11-12 hemilaminectomy. The hematoma was subarachnoid and the source of bleeding was an injured radicular vein. To the best of our knowledge, this is the first reported case of traumatic spinal subarachnoid hematoma. We discuss the possible mechanism and our case illustrates an injured radicular vein can be a source of traumatic spinal subarachnoid hematoma.
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Affiliation(s)
- Woo-Youl Jang
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, 8 Hak-dong, Dong-ku, Gwangju, 501-757, Republic of Korea
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Shimada Y, Kasukawa Y, Miyakoshi N, Hongo M, Ando S, Itoi E. Chronic subdural hematoma coexisting with ligamentum flavum hematoma in the lumbar spine: a case report. TOHOKU J EXP MED 2006; 210:83-9. [PMID: 16960349 DOI: 10.1620/tjem.210.83] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We present a case of a chronic spinal subdural hematoma combined with a ligamentum flavum hematoma in the lumbar spine treated surgically. An 83-year-old woman receiving antiplatelet medicine due to an angina suffered from pain in her lower extremity and gait disturbance after a backward fall. Radiological findings including magnetic resonance imaging (MRI) revealed hematoma in the ligamentum flavum at the level of L2 - L3 and a chronic subdural hematoma at the level from L3 to L5. Laminectomy through L2 to L5 was performed and a hematoma existing in the ligamentum flavum and cystic mass was removed. A chronic subdural hematoma was spontaneously evacuated after splitting of the dura mater and an intact arachnoid membrane was observed with no leakage of cerebrospinal fluid. Her clinical symptoms completely disappeared after surgery. To the best of our knowledge, this is the first case of combination of chronic subdural hematoma and ligamentum flavum hematoma in the lumbar spine treated by surgery. Chronic spinal subdural hematoma and hematoma in the ligamentum flavum should be considered as a cause of progressive nerve root compression in patients with anticoagulant therapy, and an appropriate pre-operative diagnosis would be needed to achieve complete decompression of subdural and epidural hematoma.
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Affiliation(s)
- Yoichi Shimada
- Rehabilitation Division, Akita University Hospital, Japan.
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Jimbo H, Asamoto S, Mitsuyama T, Hatayama K, Iwasaki Y, Fukui Y. Spinal chronic subdural hematoma in association with anticoagulant therapy: a case report and literature review. Spine (Phila Pa 1976) 2006; 31:E184-7. [PMID: 16540860 DOI: 10.1097/01.brs.0000202760.30257.88] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A case of spinal chronic subdural hematoma (SCSDH) in association with anticoagulant therapy was treated surgically. OBJECTIVE To clarify the etiopathogenesis, clinical presentation, and surgical outcomes of SCSDH. SUMMARY OF BACKGROUND DATA Intracranial chronic subdural hematoma is a well-recognized complication of anticoagulant therapy. However, SCSDH is very rare and its etiopathogenesis is uncertain. METHODS A 72-year-old man with SCSDH who had received anticoagulant therapy for atrial fibrillation complained of bilateral lower extremity pain, cramps, and gait disturbance. The patient underwent an operation for evacuation of the hematoma. RESULTS Lower-extremity pain, cramps, and gait disturbance improved, and the patient was discharged 10 days after surgery. CONCLUSION SCSDH should be included in the differential diagnosis of progressive spinal cord and nerve root compression in patients receiving anticoagulant therapy. Prompt diagnosis and early surgical decompression lead to a good outcome.
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MESH Headings
- Aged
- Anticoagulants/adverse effects
- Diagnosis, Differential
- Hematoma, Subdural, Chronic/chemically induced
- Hematoma, Subdural, Chronic/diagnostic imaging
- Hematoma, Subdural, Chronic/surgery
- Hematoma, Subdural, Spinal/chemically induced
- Hematoma, Subdural, Spinal/diagnostic imaging
- Hematoma, Subdural, Spinal/surgery
- Humans
- Male
- Radiography
- Spinal Cord Compression/diagnostic imaging
- Spinal Cord Compression/surgery
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Affiliation(s)
- Hiroyuki Jimbo
- Department of Neurosurgery, International University of Health and Welfare, Mita Hospital, Tokyo, Japan.
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Ozgen S, Baykan N, Dogan IV, Konya D, Pamir MN. Cauda equina syndrome after induction of spinal anesthesia. Neurosurg Focus 2004; 16:e5. [PMID: 15202875 DOI: 10.3171/foc.2004.16.6.5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In this report the authors present a case of cauda equina syndrome that developed following induction of spinal anesthesia in a patient who had no apparent preexisting bleeding abnormality. An acute subdural hematoma caused the syndrome and was believed to have resulted from direct vascular trauma during administration of spinal anesthesia or from vascular trauma combined with thrombocytopenia in the postoperative period.
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Affiliation(s)
- Serdar Ozgen
- Department of Neurosurgery, Marmara University Faculty of Medicine, Istanbul, Turkey.
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Bortolotti C, Wang H, Fraser K, Lanzino G. Subacute spinal subdural hematoma after spontaneous resolution of cranial subdural hematoma: causal relationship or coincidence? Case report. J Neurosurg 2004; 100:372-4. [PMID: 15070147 DOI: 10.3171/spi.2004.100.4.0372] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The etiopathogenesis of traumatic spinal subdural hematoma (SSH) is uncertain. Unlike the supratentorial subdural space, no bridging veins traverse the spinal subdural space. The authors describe a case of subacute SSH that occurred after spontaneous resolution of traumatic intracranial SDH and suggest a causal relationship between the two. A 23-year-old woman suffered an acute intracranial SDH after a snowboarding accident. There was no clinical or radiological evidence of spine injury. Conservative management of the supratentorial SDH resulted in spontaneous radiologically documented resolution with redistribution of blood in the subdural space. Four days after the injury, the patient started noticing new onset of mild low-back pain. The pain progressively worsened. Magnetic resonance imaging of the lumbosacral spine 10 days after the original injury revealed a large L4-S2 SDH. Ten days after the original injury, bilateral L5-S1 laminotomy and drainage of the subacute spinal SDH were performed. The patient experienced immediate pain relief. The authors hypothesize that in some cases spinal SDH may be related to redistribution of blood from the supratentorial subdural space.
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Affiliation(s)
- Carlo Bortolotti
- Department of Neurosurgery, Illinois Neurological Institute, University of Illinois College of Medicine at Peoria, Illinois 61637, USA
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Kahraman S, Sirin S, Kayali H, Solmaz I, Bedük A. Low back pain due to spinal chronic subdural hematoma mimicking intradural tumor in the lumbar area: a case report and literature review. THE JOURNAL OF PAIN 2003; 4:471-5. [PMID: 14622668 DOI: 10.1067/s1526-5900(03)00732-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Although magnetic resonance imaging has dramatically enhanced the ability to diagnose spinal mass lesions, some lesions remain difficult to diagnose. We report a spinal chronic subdural hematoma that comprised the cauda equina ventrally in the lumbar area in a 51-year-old man who was under anticoagulant therapy. Low back pain was the only symptom of the patient after sports activity. Surgical treatment was performed 2 months after the onset of symptoms. Intraoperative view showed chronic subdural hematoma with abnormal enlarged dural vascularization. The patient had no preoperative and postoperative neurologic deficit. Low back pain with sudden onset after minor trauma refractory to medical treatment must be investigated with magnetic resonance imaging in patients under anticoagulant therapy for spinal hematoma because of the possibility of spinal chronic subdural hematoma.
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Affiliation(s)
- Serdar Kahraman
- Department of Neurosurgery, Gülhane Military Medical Academy, Ankara, Turkey.
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Abstract
A 63-year-old woman developed acute back pain and sciatica after playing hula-hoop. Urinary incontinence was also noted. Magnetic resonance imaging revealed acute thoracolumbar spinal subdural hematoma. After emergency surgical decompression and evacuation of the spinal subdural hematoma, the patient had good recovery without any postoperative neurologic deficit. In this article, we describe and review the clinical presentations, characteristic findings from imaging studies, and treatment of spinal subdural hematoma.
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Affiliation(s)
- Jiao-Chiao Yang
- Division of Neurosurgery, Department of Surgery, Cathay General Hospital, Taipei, Taiwan
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Bosch PP, Vogt MT, Ward WT. Pediatric spinal cord injury without radiographic abnormality (SCIWORA): the absence of occult instability and lack of indication for bracing. Spine (Phila Pa 1976) 2002; 27:2788-800. [PMID: 12486348 DOI: 10.1097/00007632-200212150-00009] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective review of medical records and imaging studies of children diagnosed with spinal cord injury without radiographic abnormality (SCIWORA) or SCIWORA-like symptoms at Children's Hospital of Pittsburgh between 1965 and 1999 was undertaken. OBJECTIVES To evaluate the existence of occult segmental spinal instability and a role for bracing as treatment for SCIWORA, we contrasted the Children's Hospital of Pittsburgh experience with literature reports on SCIWORA. SUMMARY OF BACKGROUND DATA There is a great deal of confusion and conflicting evidence regarding pediatric SCIWORA in the literature. Previous reports from our institution reported unique findings, including the only description of serious, recurrent SCIWORA in the literature. These findings have frequently been cited as the justification for long-term immobilization in all cases of SCIWORA. METHODS All records on patients coded as spinal cord injury without fracture or dislocation (ICD-9 code 952.xx) were reviewed. Children 17 years of age or younger with traumatic spinal cord injury and normal plain radiographic findings were included. Penetrating trauma, infection, or metabolic diseases were excluded. RESULTS A total of 189 patients were diagnosed with SCIWORA at our institution over the 35-year review period. These patients differed from those reported in the literature with respect to a higher incidence, older age, less involved neurologic injury, and more low-energy mechanisms, such as sports and falls. There were no cases of a patient with SCIWORA who deteriorated and developed a permanent neurologic deficit after having either recovered or plateaued from an initial SCIWORA. All recurrent SCIWORA recovered to normal neurologic function. Bracing did not demonstrate any benefit in preventing these minor recurrent SCIWORAs. CONCLUSION We identified no cases of serious, recurrent SCIWORA at our institution from 1965 to 1999. A case-by-case evaluation is required for the treatment of spinal cord injury without apparent spinal column injury, and bracing is not uniformly indicated.
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Affiliation(s)
- Patrick P Bosch
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Abstract
STUDY DESIGN A case report with a literature review is presented. OBJECTIVE To describe and review the clinical presentations, characteristic findings from imaging studies, and treatment of traumatic spinal subdural hematoma. SUMMARY OF BACKGROUND DATA Traumatic spinal subdural hematoma is uncommon, and only eight cases have been reported in the literature. Concomitant intracranial and spinal subdural hematoma in the same patient has not been well studied. METHODS A case of concomitant spinal and intracranial subdural hematoma is reported as well as a review of the literature. RESULTS Including our patient, we found that five of the nine patients with traumatic spinal subdural hematoma also had intracranial hematoma. We hypothesize that the mechanism of traumatic spinal subdural hematoma may be associated with intracranial events. Recognition of blood products in magnetic resonance imaging scans is important to distinguish spinal subdural hematoma from other spinal lesions. It is generally agreed that prompt laminectomy with evacuation of hematoma should be performed before irreversible damage to the spinal cord occurs. However, including our patient, three of the nine reported cases with thoracic or lumbar subdural hematoma resolved spontaneously with conservative treatment. CONCLUSIONS This 12-year-old boy illustrated the rapid spontaneous resolution of traumatic subdural hematoma in both left hemisphere and lumbar spine with conservative treatment. This report suggests a possible role of conservative management for traumatic lumbar subdural hematoma, especially when the patients already have neurologic recovery.
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Affiliation(s)
- Kuo-Sheng Hung
- Department of Trauma and Neurosurgery, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Niao Sung Hsiang, Kaohsiung Hsien, Taiwan
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Ozkan U, Kemaloğlu MS, Aydin M, Selçuki M. Widespread post-traumatic acute spinal subdural haematoma: case report and review of the literature. Spinal Cord 2002; 40:304-6. [PMID: 12037713 DOI: 10.1038/sj.sc.3101258] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN A case report of acute post-traumatic spinal subdural haematoma (ASSH). OBJECTIVE To report a rare post-traumatic problem. SETTING Dicle University Hospital, Diyarbakir, Turkey. METHOD A 3-year-old boy was admitted to our clinic with paraplegia 24 h after falling from a height of about 5 meters. Investigation revealed an acute spinal subdural haematoma. RESULTS Following surgery there was marked improvement. The rehabilitation of the patient continues. CONCLUSION MRI is the most valuable diagnostic method. In each case diagnosed as ASSH, prompt evacuation should be performed before irreversible neurological damage occurs.
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Affiliation(s)
- U Ozkan
- Department of Neurosurgery, School of Medicine, Dicle University, Diyarbakir, Turkey
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Abstract
Spinal epidural haematoma is a rare cause of spinal cord compression. It is most commonly attributed to trauma and coagulation disorders. We report a case of a 64 year-old man with thrombocytopaenia who presented with a traumatic epidural haematoma who p resented with right hemiparesis which progressed to complete tetraplegia. MR of the cervical spine showed an epidural collection on the posterior aspect of the cord throughout the cervical spine. The patient underwent C1-C7 laminectomy and decompression. Postoperatively, the patient has improved gradually and has power of grade 3 (Medical Research Council classification of power) in all 4 limbs at 2-month follow-up. MRI is an important modality in the early diagnosis of spinal epidural haematomas and can facilitate emergent decompressive surgery which offers the best chance of neurological improvement.
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Affiliation(s)
- Wai Hoe Ng
- Department of Neurosurgery, National Neuroscience Institute, Singapore
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Abstract
STUDY DESIGN The clinical data, magnetic resonance imaging, intraoperative findings, and functional outcome were reviewed for three patients under anticoagulant therapy who experienced acute nontraumatic spinal subdural hematoma. OBJECTIVES To draw attention to this rare complication of anticoagulant therapy and to assess the magnetic resonance findings and clinical outcome of patients with spinal subdural hematoma after surgical evacuation. SUMMARY OF BACKGROUND DATA Among intraspinal hematomas, spinal subdural hematomas are by far the least common. Magnetic resonance findings have been demonstrated in only a few cases of spinal subdural hematomas. The timing of the operation and the anatomic location of the hematoma essentially determine the functional outcome. METHODS Three case reports of spinal subdural hematomas in patients receiving anticoagulant therapy are presented. Particular interest was given to the clinical and magnetic resonance data, the intraoperative findings, and the functional outcome. RESULTS The three patients each had a complete preoperative neurologic deficit. Sagittal T1- and T2-weighted magnetic resonance images of the spine proved to have high sensitivity for defining the type of bleeding and delineating the craniocaudal extension of the hematoma. Surgical evacuation was performed within 26 hours after the onset of symptoms. Intraoperative findings showed the hematoma to be confined between the dura and the arachnoid in two patients, and to be associated with rupture into the subarachnoid space in one patient. Postoperative recovery was incomplete in two patients, and did not improve in the remaining patient. CONCLUSIONS Spinal subdural hematoma must be considered in patients under anticoagulant therapy with spontaneous signs of acute spinal cord or cauda equina compression. Magnetic resonance imaging with sagittal T1- and T2-weighted images were adequate and reliable for diagnosis of spinal subdural hematoma. On the basis of previous studies and the authors' intraoperative findings, spinal subdural hematomas could be viewed as spinal dural border hematomas. The level of preoperative neurologic deficit seemed to be critical for recovery despite prompt surgical evacuation.
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Affiliation(s)
- X Morandi
- Departments of Neurosurgery and Neuroradiology, Pontchaillou Hospital, University of Rennes, Rennes, France.
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Chen HJ, Liang CL, Lu K, Liliang PC, Tsai YD. Cauda equina syndrome caused by delayed traumatic spinal subdural haematoma. Injury 2001; 32:505-7. [PMID: 11476820 DOI: 10.1016/s0020-1383(01)00046-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- H J Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University, 123 Tapei Road, Niasung Hsiang, Kaohsiung Hsien, Taiwan.
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Boukobza M, Haddar D, Boissonet M, Merland JJ. Spinal subdural haematoma: a study of three cases. Clin Radiol 2001; 56:475-80. [PMID: 11428797 DOI: 10.1053/crad.2000.0466] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS To define the clinical, computed tomography (CT) and magnetic resonance imaging (MRI) features and the role of MRI in the follow-up of spinal subdural haematoma (SSH), and to compare these findings with those of spinal epidural haematomas (SEH). METHODS We report three cases of SSH (two women, one male, age: 50-74 years). Two patients were on anticoagulant therapy; in the other case the SSH was spontaneous. All the patients were examined 1-3 days after the onset of the symptoms. All of them had CT, two had MRI and one had angiography. Two patients underwent surgery. RESULTS The haematoma was located in the thoracolumbar region (two) and in the thoracic region (one), extending from five (two) to 11 vertebral body levels (one). The haematomas were posteriorly located with lateral extension. The transverse shape differed with the level: biconvex, biloculated or circumferential. The haematomas were hyperdense on CT. On MRI, SSH yielded high signal on both T1 and T2. The integrity of the posterior fat pads, which was well shown on CT and MRI, and the visualization of the dura mater demonstrated the intradural location of these collections, making them easily distinguishable from spinal epidural haematoma. MRI provides better evaluation of the longitudinal extent. Our results are compared with those reported in the literature. CONCLUSION MRI is superior to CT for diagnosis and follow-up of SSH. Our findings and those reported in the literature show that the MR features of SSH are quite specific and allow differentiation from SEH.
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Affiliation(s)
- M Boukobza
- Department of Neuroradiology, Hopital Lariboisiére, Paris, France
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