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Kumar N, Palmisciano P, Dhawan S, Boakye M, Drazin D, Sharma M. Spontaneous Spinal Hematoma in Patients Using Antiplatelets and Anticoagulants: A Systematic Review. World Neurosurg 2024; 184:e185-e194. [PMID: 38278210 DOI: 10.1016/j.wneu.2024.01.082] [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] [Received: 09/20/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Spontaneous spinal hematoma (SSH) is a debilitating complication in patients taking either antiplatelet (AP) or anticoagulation (AC) medications. SSH is rare and, therefore, a systematic review is warranted to re-examine and outline trends, clinical characteristics, and outcomes associated with SSH formation. METHODS PubMed, EMBASE, Scopus, and Web-of-Science were searched. Studies reporting clinical data of patients with SSH using AC medications were included. In addition, clinical studies meeting our a priori inclusion criteria limited to SSH were further defined in quality through risk bias assessment. RESULTS We included 10 studies with 259 patients' pooled data post-screening 3083 abstracts. Within the cohort (n = 259), the prevalence of idiopathic, nontraumatic SSH with concomitant treatment with AC medications was greater 191 (73.75%) compared with AP treatment (27%). The lumbar spine was the most common site of hematoma (41.70%), followed by the cervical (22.01%) and thoracic (8.49%) spine. Most patients had surgical intervention (70.27%), and 29.73% had conservative management. The pooled data suggest that immediate diagnosis and intervention are the best prognostic factors in clinical outcomes. American Spinal Injury Association grading at initial symptom onset and post-treatment showed the greatest efficacy in symptomatic relief (87.64%) and return of motor and sensory symptoms (39.19%). CONCLUSIONS Our review suggested that AC medications were related to SSH in most patients (74%), followed by APs (27%) and combined ACs + APs (1.9%). We recommend prompt intervention, a high suspicion for patients with neurologic deficits and diagnostic imaging before intervention to determine a case-specific treatment plan.
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Affiliation(s)
- Nitesh Kumar
- Clinical Medicine, Windsor University School of Medicine, Chicago, Illinois, USA
| | - Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Sanjay Dhawan
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Doniel Drazin
- Department of Neurosurgery, Providence Everett Neuroscience Center, Everett, Washington, USA
| | - Mayur Sharma
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA.
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2
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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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3
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Perillo T, Vitiello A, Carotenuto B, Perrotta M, Serino A, Manto A. Spontaneous epidural and subdural hematomas of the spine: Review of anatomy and imaging findings. Neuroradiol J 2024; 37:23-30. [PMID: 36908230 PMCID: PMC10863578 DOI: 10.1177/19714009231163553] [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: 03/14/2023] Open
Abstract
Spontaneous epidural (SEH) and subdural hematomas (SSH) of the spine are a rare cause of spinal injury and morbidity. They often present in the emergency setting, though magnetic resonance imaging is the gold-standard for diagnosis. Knowledge of anatomy, and in particular of the dural layers of the spine, is crucial to understand the location of SEH and SSH and their relationship with spinal structure. In this pictorial review, we aim to explain imaging features of the SEH and SSH, and to rule out their main differential diagnosis.
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Affiliation(s)
- Teresa Perillo
- Department of Neuroradiology, “Umberto I” Hospital, ASL Salerno, Italy
| | - Alessio Vitiello
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy
| | | | - Marianna Perrotta
- Department of Neuroradiology, “Umberto I” Hospital, ASL Salerno, Italy
| | - Antonietta Serino
- Department of Neuroradiology, “Umberto I” Hospital, ASL Salerno, Italy
| | - Andrea Manto
- Department of Neuroradiology, “Umberto I” Hospital, ASL Salerno, Italy
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4
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Simon D. Severe Mimic of Transverse Myelitis - Spontaneous Non-Traumatic Intramedullary Hematomyelia: A Case Report. Neurohospitalist 2024; 14:83-86. [PMID: 38235023 PMCID: PMC10790618 DOI: 10.1177/19418744231196931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Spinal cord hemorrhage remains an uncommon vascular pathology with no standard approach to treatment. Intramedullary hematomyelia is the rarest subtype and has only been described in case reports, making it a diagnosis easier to miss. A 55-year-old male with history of polysubstance abuse presented for abrupt onset non-traumatic back pain that progressed over several days evolving into paraplegia, sensory loss up to the T3 dermatome, and incontinence of bowel and bladder. His MRI imaging of the cervical and thoracic spine was concerning for a T1 and T2 hyperintense lesion extending from the internal medulla to the upper thoracic spine causing edema. The initial differential diagnosis, based on history and progressive neurologic decline, included a longitudinally extensive transverse mellitus of unclear etiology. He received high dose steroids and plasma exchange without any clinical improvement. An extensive autoimmune, inflammatory, infectious, and demyelinating workup via serum and CSF analysis was unremarkable. He was transferred to a tertiary facility, where repeat MRI spinal imaging included GRE sequences that was significant for increased susceptibility. MRA imaging of the spine was completed showing no vascular malformation. Overall, the diagnosis of hematomyelia was felt to be most likely. Despite aggressive inpatient rehabilitation, the patient remains paraplegic and requires long term management consistent with severe spinal cord injury. This case highlights the importance of recognizing vascular syndromes as a cause of acute myelopathy, understanding the imaging findings of blood breakdown products on MRI, and the desperate need for successful therapeutic strategies to combat a potentially devastating neurologic process.
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Affiliation(s)
- Devin Simon
- Department of Neurology and Ophthalmology, Michigan State University, Lansing, MI, USA
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5
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Hasegawa C, Saladin M, Rehli MJ, Burkhart CS. Subdural spinal haematoma after epidural anaesthesia. BMJ Case Rep 2023; 16:e255104. [PMID: 38160037 PMCID: PMC10759102 DOI: 10.1136/bcr-2023-255104] [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] [Accepted: 12/16/2023] [Indexed: 01/03/2024] Open
Abstract
Epidural anaesthesia is widely used in major thoracic and abdominal surgery for postoperative analgesia. Spinal haematoma after epidural anaesthesia in patients without risk factors is very rare. Most of the reported spinal haematomas arose in the epidural space, whereas the subdural localization seen in this case is very uncommon.We report a case of spinal subdural haematoma after difficult and repeated placement of an epidural catheter for postoperative analgesia. As no sensorimotor deficit of the lower limb arose, we refrained from immediate neurosurgical decompression and the patient recovered fully in the course. Nevertheless, any kind of spinal haematoma is a serious complication we should always be aware of. Prompt detection of clinical symptoms such as sensory or motor deficit is most important. Further diagnostic steps and treatment should not be delayed to avoid permanent neurological deficits.
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Affiliation(s)
| | - Martina Saladin
- Anaesthesiology, Kantonsspital Graubünden, Chur, Switzerland
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6
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Vierunen RM, Haapamäki VV, Koivikko MP, Bensch FV. Post-traumatic spinal hematoma in diffuse idiopathic skeletal hyperostosis (DISH). Eur Radiol 2023; 33:9425-9433. [PMID: 37382616 PMCID: PMC10667401 DOI: 10.1007/s00330-023-09866-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 03/21/2023] [Accepted: 04/25/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVES To determine the incidence of spinal hematoma and its relation to neurological deficit after trauma in patients with spinal ankylosis from diffuse idiopathic skeletal hyperostosis (DISH). MATERIALS AND METHODS A retrospective review of 2256 urgent or emergency MRI referrals over a period of 8 years and nine months revealed 70 DISH patients who underwent CT and MRI scans of the spine. Spinal hematoma was the primary outcome. Additional variables were spinal cord impingement, spinal cord injury (SCI), trauma mechanism, fracture type, spinal canal narrowing, treatment type, and Frankel grades during injury, before and after treatment. Two trauma radiologists reviewed MRI scans blinded to initial reports. RESULTS Of 70 post-traumatic patients (54 men, median age 73, IQR 66-81) with ankylosis of the spine from DISH, 34 (49%) had spinal epidural hematoma (SEH) and 3 (4%) had spinal subdural hematoma, 47 (67%) had spinal cord impingement, and 43 (61%) had SCI. Ground-level fall (69%) was the most common trauma mechanism. A transverse, AO classification type B spine fracture (39%) through the vertebral body was the most common injury type. Spinal canal narrowing (p < .001) correlated and spinal cord impingement (p = .004) associated with Frankel grade before treatment. Of 34 patients with SEH, one, treated conservatively, developed SCI. CONCLUSIONS SEH is a common complication after low-energy trauma in patients with spinal ankylosis from DISH. SEH causing spinal cord impingement may progress to SCI if not treated by decompression. CLINICAL RELEVANCE STATEMENT Low-energy trauma may cause unstable spinal fractures in patients with spinal ankylosis caused by DISH. The diagnosis of spinal cord impingement or injury requires MRI, especially for the exclusion of spinal hematoma requiring surgical evacuation. KEY POINTS • Spinal epidural hematoma is a common complication in post-traumatic patients with spinal ankylosis from DISH. • Most fractures and associated spinal hematomas in patients with spinal ankylosis from DISH result from low-energy trauma. • Spinal hematoma can cause spinal cord impingement, which may lead to SCI if not treated by decompression.
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Affiliation(s)
- Riku M Vierunen
- Department of Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, 00029, Helsinki, Finland.
| | - Ville V Haapamäki
- Department of Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, 00029, Helsinki, Finland
| | - Mika P Koivikko
- Department of Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, 00029, Helsinki, Finland
| | - Frank V Bensch
- Department of Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, 00029, Helsinki, Finland
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7
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Andour H, Abide Z, Cherraqi A, Mouhassani M, En-Nafaa I, Fenni J, Lahkim M. Pain in the back after a brain trauma-The revelation of a spinal subdural hematoma: A case report with a literature review. SAGE Open Med Case Rep 2023; 11:2050313X231204771. [PMID: 37829351 PMCID: PMC10566262 DOI: 10.1177/2050313x231204771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 09/14/2023] [Indexed: 10/14/2023] Open
Abstract
Traumatic spinal subdural hematoma is a rare condition mostly favored by an anticoagulation therapy, a traumatic lumbar puncture, a hematologic disease, or an epidural anesthesia. This pathological condition can be subtle or be at the origin of a compression of the spinal cord and the rootlets resulting in an irreversible damage if an emergent surgery is not performed. We report the case of a 45-year-old man who has been a victim of a brain trauma which resulted in a cerebral edema. A week later, the patient came to the emergency department for disabling abdominal pain, predominant in the back. An abdominal computed tomography was performed and showed an incidentally spontaneous hyperdensity in the spinal cord, which raised the suspicion of a spinal hematoma that has been confirmed through spine magnetic resonance imaging. In this case, we discuss the different subtypes of spinal hematoma. We recall the main differential diagnoses to help setting an accurate diagnosis and to not delay the adequate therapy that is most of the time emergent when indicated.
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Affiliation(s)
- Hajar Andour
- Radiology Department, Military Hospital Mohamed V-Rabat, Rabat, Morocco
| | - Zakaria Abide
- Radiology Department, Military Hospital Mohamed V-Rabat, Rabat, Morocco
| | - Amine Cherraqi
- Radiology Department, Military Hospital Mohamed V-Rabat, Rabat, Morocco
| | - Mohamed Mouhassani
- Neurosurgery Department, Military Hospital Mohamed V-Rabat, Rabat, Morocco
| | - Issam En-Nafaa
- Radiology Department, Military Hospital Mohamed V-Rabat, Rabat, Morocco
| | - Jamal Fenni
- Radiology Department, Military Hospital Mohamed V-Rabat, Rabat, Morocco
| | - Mohamed Lahkim
- Radiology Department, Military Hospital Mohamed V-Rabat, Rabat, Morocco
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8
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Padilha IG, Fonseca APA, Amancio CT, Vieira APF, Pacheco FT, da Rocha AJ. Vascular Myelopathies. Semin Ultrasound CT MR 2023; 44:408-423. [PMID: 37690793 DOI: 10.1053/j.sult.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
There are many vascular disorders that can affect the spinal cord, and their prevalence and etiology are highly influenced by age, sex, and risk factors. This article reviews the embryology and anatomy of the spinal cord, as well as several vascular conditions, describing their clinical and imaging presentation, emphasizing the different imaging modalities' contributions to increasing specificity and better defining the most appropriate therapy strategy for improving the patient's prognosis.
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Affiliation(s)
- Igor Gomes Padilha
- Division of Neuroradiology, Diagnósticos da América SA-DASA, São Paulo, SP, Brazil; Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, SP, Brazil; Division of Neuroradiology, Unitedhealth Group, São Paulo, SP, Brazil.
| | - Ana Paula Alves Fonseca
- Division of Neuroradiology, Diagnósticos da América SA-DASA, São Paulo, SP, Brazil; Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, SP, Brazil; Division of Neuroradiology, Unitedhealth Group, São Paulo, SP, Brazil
| | - Camila Trolez Amancio
- Division of Neuroradiology, Diagnósticos da América SA-DASA, São Paulo, SP, Brazil; Division of Neuroradiology, Hospital Sirio-Libanês, São Paulo, SP, Brazil
| | | | - Felipe Torres Pacheco
- Division of Neuroradiology, Diagnósticos da América SA-DASA, São Paulo, SP, Brazil; Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, SP, Brazil
| | - Antônio José da Rocha
- Division of Neuroradiology, Diagnósticos da América SA-DASA, São Paulo, SP, Brazil; Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, SP, Brazil
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9
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Mazur-Hart DJ, Nguyen KT, Pettersson DR, Ross DA. Early postoperative MRI findings following anterior cervical discectomy and fusion: What to expect when the unexpected happens. World Neurosurg X 2023; 19:100188. [PMID: 37026085 PMCID: PMC10070176 DOI: 10.1016/j.wnsx.2023.100188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/14/2023] [Accepted: 03/16/2023] [Indexed: 04/08/2023] Open
Abstract
Background Magnetic resonance imaging (MRI) is not routinely ordered following spinal fusion. Some literature suggests MRIs are unhelpful due to postoperative changes that obscure interpretation. We aim to describe findings of acute postoperative MRI following anterior cervical discectomy and fusion (ACDF). Methods The authors retrospectively analyzed adult MRIs completed within 30 days of ACDF (from 2005-2022). T1 and T2 signal intensity in the interbody space dorsal to the graft, mass effect on the dura/spinal cord, intrinsic spinal cord T2 signal, and interpretability were reviewed. Results In 38 patients there were 58 ACDF levels (1, 2, and 3 levels; 23, 10, and 5, respectively). MRIs were completed on mean postoperative day 8.37 (range; 0-30 days). T1-weighted imaging was described as isointense, hyperintense, heterogenous, and hypointense in 48 (82.8%), 5 (8.6%), 3 (5.2%), and 2 levels (3.4%), respectively. T2-weighted imaging was described as hyperintense, heterogenous, isointense, and hypointense in 41 (70.7%), 12 (20.7%), 3 (5.2%), and 2 levels (3.4%), respectively. There was no mass effect in 27 levels (46.6%), 14 (24.1%) had thecal sac compression, and 17 (29.3%) had cord compression. Conclusions The majority of MRIs exhibited readily compression and intrinsic spinal cord signal even with various types of fusion constructs. Early MRI after lumbar surgery can be difficult to interpret. However, our results support the use of early MRI to investigate neurological complaints following ACDF. Our findings do not support the idea that epidural blood products and mass effect on the cord are seen in most postoperative MRIs after ACDF.
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Affiliation(s)
- David J. Mazur-Hart
- Department of Neurological Surgery, Oregon Health & Science University, 3303 South Bond Avenue, Portland, OR, USA
| | - Kristey T. Nguyen
- Department of Neurological Surgery, Oregon Health & Science University, 3303 South Bond Avenue, Portland, OR, USA
| | - David R. Pettersson
- Department of Diagnostic Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - Donald A. Ross
- Department of Neurological Surgery, Oregon Health & Science University, 3303 South Bond Avenue, Portland, OR, USA
- Operative Care Division, Portland Veterans Administration, 3710 SW US Veterans Hospital Road, Portland, OR, USA
- Corresponding author. Department of Neurological Surgery, Oregon Health & Science University, CH8N, 3303 South Bond Avenue, Portland, OR, 97239, USA.
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10
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Bhosle R, Raju D, Patel SS, Aditya G, Shukla J, Ghosh N, Krishnan P. Spinal Subdural Hematoma following Epidural Anesthesia. Asian J Neurosurg 2023; 18:347-351. [PMID: 37397056 PMCID: PMC10313436 DOI: 10.1055/s-0043-1768576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023] Open
Abstract
The spinal subdural space is an avascular, potential space and is a rare location for intraspinal hematomas. Compared to spinal epidural hematomas, spinal subdural hematomas are uncommonly described complications of lumbar puncture for spinal or epidural anesthesia, particularly in patients who have no pre-existing bleeding disorders or history of antiplatelet or anticoagulant intake. We describe a 19-year-old girl who had a large thoracolumbar spinal subdural hematoma following epidural anesthesia for elective cholecystectomy with no pre-existing bleeding diathesis that caused rapidly developing paraplegia that evolved over the next 2 days following surgery. Nine days after the initial surgery she underwent multilevel laminectomy and surgical evacuation with eventual satisfactory recovery. Even epidural anesthesia without thecal sac violation can result in bleeding in the spinal subdural space. The possible sources of bleed in this space may be from injury to an interdural vein or extravasation of subarachnoid bleed into the subdural space. When neurological deficits occur, prompt imaging is mandatory and early evacuation yields gratifying results.
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Affiliation(s)
- Rajesh Bhosle
- Department of Neurosurgery, National Neurosciences Centre, Kolkata, West Bengal, India
| | - Dimble Raju
- Department of Neurosurgery, National Neurosciences Centre, Kolkata, West Bengal, India
| | | | - Grandhi Aditya
- Department of Neurosurgery, National Neurosciences Centre, Kolkata, West Bengal, India
| | - Jagriti Shukla
- Department of Neurosurgery, National Neurosciences Centre, Kolkata, West Bengal, India
| | - Nabanita Ghosh
- Department of Neurosurgery, National Neurosciences Centre, Kolkata, West Bengal, India
| | - Prasad Krishnan
- Department of Neurosurgery, National Neurosciences Centre, Kolkata, West Bengal, India
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11
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Alrazooqi MK, Skikic E, Iqbal SS, Sulaiman L, Muhammed Noori OQ. Traumatic Spinal Epidural Hematoma With Significant Neurologic Findings: A Case Report. Cureus 2023; 15:e38869. [PMID: 37188062 PMCID: PMC10181898 DOI: 10.7759/cureus.38869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 05/17/2023] Open
Abstract
Traumatic spinal epidural hematoma (TSEH) is a rare neurosurgical emergency. Our case report centers around a young 34-year-old female brought into our emergency department after a front and rear motor vehicle collision. Clinical deterioration and imaging studies revealed a large spinal epidural hematoma extending from levels C5 to T2. The patient was subsequently transferred to a different hospital for further management. This case involved a multidisciplinary approach by the combined effort of emergency medicine physicians, neurosurgeons, orthopedic trauma surgeons, general surgeons, radiologists, intensive care specialists, anesthesiologists, paramedics and nurses.
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Affiliation(s)
- Maryam K Alrazooqi
- Emergency Medicine, Rashid Hospital Trauma Centre/Dubai Academic Health Corporation, Dubai, ARE
| | - Ena Skikic
- Emergency Medicine, Rashid Hospital Trauma Centre/Dubai Academic Health Corporation, Dubai, ARE
| | - Shaikh S Iqbal
- Radiology, Rashid Hospital Trauma Centre/Dubai Academic Health Corporation, Dubai, ARE
| | - Lara Sulaiman
- Emergency Medicine, Rashid Hospital Trauma Centre/Dubai Academic Health Corporation, Dubai, ARE
| | - Omar Q Muhammed Noori
- Emergency Medicine, Rashid Hospital Trauma Centre/Dubai Academic Health Corporation, Dubai, ARE
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12
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West N, Butterfield S, Rusbridge C, Fernandez A, Tabanez J, Rudolf NJ, Archer S, Whittaker D. Non-traumatic hemorrhagic myelopathy in dogs. J Vet Intern Med 2023; 37:1129-1138. [PMID: 37095733 DOI: 10.1111/jvim.16694] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/17/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Non-traumatic spinal cord hemorrhage (NTSH) is an uncommon cause of myelopathy in dogs. OBJECTIVES Describe the clinical characteristics, concurrent medical conditions and underlying causes, magnetic resonance imaging (MRI) findings and outcome in dogs with NTSH. ANIMALS Dogs diagnosed with NTSH using gradient echo T2-weighted (GRE) sequences with or without histopathological confirmation of hemorrhage were included. Dogs with a traumatic cause were excluded, including those with compressive intervertebral disc extrusion. METHODS Retrospective descriptive study; the databases of 2 referral hospitals were searched between 2013 and 2021. RESULTS Twenty-three dogs met inclusion criteria. The onset of signs was acute and progressive in 70% of cases; spinal hyperesthesia was variable (48%). Hemorrhage was identified in the thoracolumbar spinal segments in 65% of dogs. An underlying cause was identified in 65% of cases. Angiostrongylus vasorum represented 18% of the total cohort, followed by steroid-responsive meningitis arteritis (SRMA; 13%). Overall, 64% of dogs had a good or excellent outcome, regardless of cause; which was increased to 100% for SRMA, 75% for A. vasorum and 75% for idiopathic NTSH. Outcome was not associated with neurological severity. Recovery rate was 67% and 50% for nociception-intact and nociception-negative dogs, respectively. CONCLUSIONS Larger prospective studies would be required to define prognostic factors for dogs with NTSH, but outcome appeared to be most influenced by the underlying cause, as opposed to neurological severity at presentation.
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Affiliation(s)
- Natalie West
- Fitzpatrick Referrals Ltd, Halfway ln, Godalming, UK
- North Downs Specialist Referrals, part of Linnaeus Veterinary Limited, Bletchingley, UK
| | - Sarah Butterfield
- The Queen Mother Hospital for Small Animals, Royal Veterinary College
| | - Clare Rusbridge
- Fitzpatrick Referrals Ltd, Halfway ln, Godalming, UK
- The University of Surrey, Surrey, UK
- Wear Referrals, County Durham, UK
| | - Ana Fernandez
- Fitzpatrick Referrals Ltd, Halfway ln, Godalming, UK
| | - Joana Tabanez
- Fitzpatrick Referrals Ltd, Halfway ln, Godalming, UK
| | | | | | - Danielle Whittaker
- Fitzpatrick Referrals Ltd, Halfway ln, Godalming, UK
- The Queen Mother Hospital for Small Animals, Royal Veterinary College
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13
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Detection of Critical Spinal Epidural Lesions on CT Using Machine Learning. Spine (Phila Pa 1976) 2023; 48:1-7. [PMID: 35905328 DOI: 10.1097/brs.0000000000004438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/12/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Critical spinal epidural pathologies can cause paralysis or death if untreated. Although magnetic resonance imaging is the preferred modality for visualizing these pathologies, computed tomography (CT) occurs far more commonly than magnetic resonance imaging in the clinical setting. OBJECTIVE A machine learning model was developed to screen for critical epidural lesions on CT images at a large-scale teleradiology practice. This model has utility for both worklist prioritization of emergent studies and identifying missed findings. MATERIALS AND METHODS There were 153 studies with epidural lesions available for training. These lesions were segmented and used to train a machine learning model. A test data set was also created using previously missed epidural lesions. The trained model was then integrated into a teleradiology workflow for 90 days. Studies were sent to secondary manual review if the model detected an epidural lesion but none was mentioned in the clinical report. RESULTS The model correctly identified 50.0% of epidural lesions in the test data set with 99.0% specificity. For prospective data, the model correctly prioritized 66.7% of the 18 epidural lesions diagnosed on the initial read with 98.9% specificity. There were 2.0 studies flagged for potential missed findings per day, and 17 missed epidural lesions were found during a 90-day time period. These results suggest almost half of critical spinal epidural lesions visible on CT imaging are being missed on initial diagnosis. CONCLUSION A machine learning model for identifying spinal epidural hematomas and abscesses on CT can be implemented in a clinical workflow.
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Malomo T, Allard Brown A, Bale K, Yung A, Kozlowski P, Heran M, Streijger F, Kwon BK. Quantifying Intraparenchymal Hemorrhage after Traumatic Spinal Cord Injury: A Review of Methodology. J Neurotrauma 2022; 39:1603-1635. [PMID: 35538847 DOI: 10.1089/neu.2021.0317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Intraparenchymal hemorrhage (IPH) after a traumatic injury has been associated with poor neurological outcomes. Although IPH may result from the initial mechanical trauma, the blood and its breakdown products have potentially deleterious effects. Further, the degree of IPH has been correlated with injury severity and the extent of subsequent recovery. Therefore, accurate evaluation and quantification of IPH following traumatic spinal cord injury (SCI) is important to define treatments' effects on IPH progression and secondary neuronal injury. Imaging modalities, such as magnetic resonance imaging (MRI) and ultrasound (US), have been explored by researchers for the detection and quantification of IPH following SCI. Both quantitative and semiquantitative MRI and US measurements have been applied to objectively assess IPH following SCI, but the optimal methods for doing so are not well established. Studies in animal SCI models (rodent and porcine) have explored US and histological techniques in evaluating SCI and have demonstrated the potential to detect and quantify IPH. Newer techniques using machine learning algorithms (such as convolutional neural networks [CNN]) have also been studied to calculate IPH volume and have yielded promising results. Despite long-standing recognition of the potential pathological significance of IPH within the spinal cord, quantifying IPH with MRI or US is a relatively new area of research. Further studies are warranted to investigate their potential use. Here, we review the different and emerging quantitative MRI, US, and histological approaches used to detect and quantify IPH following SCI.
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Affiliation(s)
- Toluyemi Malomo
- International Collaboration on Repair Discoveries, Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Aysha Allard Brown
- International Collaboration on Repair Discoveries, Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kirsten Bale
- International Collaboration on Repair Discoveries, Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.,UBC MRI Research Center, Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Yung
- International Collaboration on Repair Discoveries, Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.,UBC MRI Research Center, Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Piotr Kozlowski
- International Collaboration on Repair Discoveries, Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.,UBC MRI Research Center, Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Manraj Heran
- Department of Radiology, Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Femke Streijger
- International Collaboration on Repair Discoveries, Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian K Kwon
- International Collaboration on Repair Discoveries, Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Spine Surgery Institute, Department of Orthopaedics, and Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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15
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Hemophilia A Resulting in Severe Hyperesthesia Due to Extraparenchymal Spinal Cord Hemorrhage in a Young Golden Retriever Puppy. Vet Sci 2022; 9:vetsci9110638. [DOI: 10.3390/vetsci9110638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/07/2022] [Accepted: 11/12/2022] [Indexed: 11/19/2022] Open
Abstract
A ten-week-old male Golden retriever puppy was presented with severe hyperesthesia, mild neurological deficits and episcleral bleeding. Clotting times showed a normal prothrombin time (PT) and prolonged activated partial thromboplastin time (aPPT). Computed tomography (CT) of the vertebral column showed intradural, extraparenchymal hyperattenuating changes on precontrast CT images and epidural mass lesions, suggestive of hematorrhachis. Hemophilia A was confirmed by a low-factor VIII activity (FVIII:C). Although the dog improved clinically with intravenous analgesia and cage rest, it was euthanized by the owners’ choice because of the risk of developing future episodes of spontaneous hemorrhage. In young male puppies with severe hyperesthesia and mild neurological deficits, hemophilia A should be considered as a possible differential diagnosis.
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16
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Muacevic A, Adler JR, Nga YS, Shum JS. Concurrent Spinal and Intracranial Subdural Hematomas as a Cause of Near-Fatal Low Back Pain in the Chiropractic Office: A Case Report. Cureus 2022; 14:e31900. [PMID: 36579221 PMCID: PMC9792299 DOI: 10.7759/cureus.31900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2022] [Indexed: 11/27/2022] Open
Abstract
In older individuals, minor trauma may cause potentially fatal intracranial subdural hematoma (SDH). Rarely, these patients present with only low back and radicular pain as gravity redistributes the SDH to the lumbar spine. A 69-year-old male presented to a chiropractor with a 10-day history of acute on chronic low back pain, which radiated into his lower extremities bilaterally, involving weakness and difficulty walking, and a ground-level fall onto his elbows 16 days prior. He had visited his primary care provider, orthopedist, and traditional Chinese medicine practitioner, received oral analgesics and three ketorolac injections, and had lumbar radiographs, followed by acupuncture, cupping, and spinal manipulation without lasting relief. Considering the patient's concerning presentation, the chiropractor ordered lumbar magnetic resonance imaging (MRI) on the first visit, revealing findings suggestive of late subacute lumbar SDH, and recommended urgent brain MRI and neurosurgical referral. The patient went to an orthopedic surgeon at a nearby hospital, becoming disoriented upon presentation, prompting admission. Brain MRI confirmed bilateral chronic intracranial SDH, prompting emergency hematoma evacuation via burr hole craniostomy. The patient's gait rapidly improved, and the pain subsided over the following two weeks. This case highlights an older male identified as having spinal SDH by a chiropractor, leading to referral and surgery for concurrent life-threatening intracranial SDH. Clinicians should be aware that spinal SDH may stem from asymptomatic intracranial SDH and should be suspicious of SDH in older individuals after a fall, signs of which warrant emergency referral for MRI and surgical evaluation.
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17
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Butler AJ, Donnally CJ, Goz V, Basques BA, Vaccaro AR, Schroeder GD. Symptomatic Postoperative Epidural Hematoma in the Lumbar Spine. Clin Spine Surg 2022; 35:354-362. [PMID: 34923504 DOI: 10.1097/bsd.0000000000001278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/15/2021] [Indexed: 01/25/2023]
Abstract
A symptomatic postoperative epidural hematoma (SPEH) in the lumbar spine is a complication with variable presentation and the potential to rapidly cause an irrecoverable neurological injury. Significant heterogeneity exists among current case series reporting SPEH in the literature. This review attempts to clarify the known incidence, risk factors, and management pearls. Currently, literature does not support the efficacy of subfascial drains in reducing the incidence of SPEHs and possibly suggests that medication for thromboembolism prophylaxis may increase risk. Acute back pain and progressing lower extremity motor weakness are the most common presenting symptoms of SPEH. Magnetic resonance imaging is the mainstay of diagnostic imaging necessary to confirm the diagnosis, but if not acutely available, an immediate return to the operative theater for exploration without advanced imaging is justified. Treatment of a SPEH consists of emergent hematoma evacuation as a delay in repeat surgery has a deleterious effect on neurological recovery. Outcomes are poorly defined, though a significant portion of patients will have lasting neurological impairments even when appropriately recognized and managed.
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Affiliation(s)
- Alexander J Butler
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, FL
| | - Chester J Donnally
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Vadim Goz
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Bryce A Basques
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
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18
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Mehta SH, Shah KA, Werner CD, White TG, Lo SFL. Ventral Spinal Cord Herniation Causing Spinal Intradural Hematoma and Subarachnoid Hemorrhage: A Case Report. Cureus 2022; 14:e28349. [PMID: 36168337 PMCID: PMC9506680 DOI: 10.7759/cureus.28349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 11/23/2022] Open
Abstract
Ventral spinal cord herniation is a rare pathology, caused by a dural defect, that leads to progressive myelopathy. The true prevalence of ventral spinal cord herniation is unknown largely because of underdiagnosis due to its nonspecific symptoms. Though there are theories that attempt to describe how these dural defects are formed, the true causes of these defects are unknown. In this case report, we present a case of a 29-year-old female who had an idiopathic ventral spinal cord herniation causing an intradural hematoma and subarachnoid hemorrhage. This is the first reported case of spinal cord herniation causing hemorrhage.
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19
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Bai J, Grant K, Hussien A, Kawakyu-O'Connor D. Imaging of metastatic epidural spinal cord compression. FRONTIERS IN RADIOLOGY 2022; 2:962797. [PMID: 37492671 PMCID: PMC10365281 DOI: 10.3389/fradi.2022.962797] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/18/2022] [Indexed: 07/27/2023]
Abstract
Metastatic epidural spinal cord compression develops in 5-10% of patients with cancer and is becoming more common as advancement in cancer treatment prolongs survival in patients with cancer (1-3). It represents an oncological emergency as metastatic epidural compression in adjacent neural structures, including the spinal cord and cauda equina, and exiting nerve roots may result in irreversible neurological deficits, pain, and spinal instability. Although management of metastatic epidural spinal cord compression remains palliative, early diagnosis and intervention may improve outcomes by preserving neurological function, stabilizing the vertebral column, and achieving localized tumor and pain control. Imaging serves an essential role in early diagnosis of metastatic epidural spinal cord compression, evaluation of the degree of spinal cord compression and extent of tumor burden, and preoperative planning. This review focuses on imaging features and techniques for diagnosing metastatic epidural spinal cord compression, differential diagnosis, and management guidelines.
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20
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Cunha B, Rodrigues A, Gonçalves J, Conceição C. Imaging of intraspinal cystic lesions: A review. J Neuroimaging 2022; 32:1044-1061. [PMID: 35942824 DOI: 10.1111/jon.13037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/21/2022] [Accepted: 07/28/2022] [Indexed: 11/29/2022] Open
Abstract
Several distinct conditions present as cystic or pseudocystic lesions within the spinal canal. Some of the most common spinal cystic lesions include spinal meningeal cysts, juxtafacet cysts, dermoid/epidermoid cysts, nerve sheath tumors, and syringohydromyelia. Clinical presentation is usually nonspecific and imaging characteristics are frequently overlapping, which may pose a challenging presurgical diagnosis. We provide a pictorial review of cystic intraspinal lesions and discuss the main imaging features that can aid the neuroradiologist in the differential diagnosis. First, we propose a categorization of the lesions according to their location as extradural, intradural extramedullary, and intramedullary. This is a crucial initial step in the diagnostic workup and surgical planning. Second, for each of these locations, we organize the lesions according to their etiology: congenital and developmental disorders, degenerative disorders, traumatic or postsurgical collections, infectious conditions, neoplastic lesions, and other miscellaneous disorders. Finally, we summarize the clinical highlights and MR features that provide important insights for the differential diagnosis. MR is the technique of choice in presurgical evaluation and postsurgery follow-up. It provides accurate lesion localization and characterization and, most of the times, it will allow a confident differential diagnosis. High-resolution three-dimensional T2-weighted sequences and diffusion-weighted imaging can provide important hints in specific cases. Signal correlation with T1-weighted and fat-saturated sequences allows to differentiate true cystic lesions from hemorrhage or fat tissue.
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Affiliation(s)
- Bruno Cunha
- Neuroradiology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.,NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Alexandra Rodrigues
- Neuroradiology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.,NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal.,Unidade de Neurorradiologia, Hospital Central do Funchal, Funchal, Portugal
| | - João Gonçalves
- Neuroradiology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.,NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal.,Unidade de Neurorradiologia, Hospital Central do Funchal, Funchal, Portugal
| | - Carla Conceição
- Neuroradiology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
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21
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Ruiz Santiago F, Láinez Ramos-Bossini AJ, Wáng YXJ, Martínez Barbero JP, García Espinosa J, Martínez Martínez A. The value of magnetic resonance imaging and computed tomography in the study of spinal disorders. Quant Imaging Med Surg 2022; 12:3947-3986. [PMID: 35782254 PMCID: PMC9246762 DOI: 10.21037/qims-2022-04] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/13/2022] [Indexed: 08/15/2023]
Abstract
Computed tomography (CT) and magnetic resonance imaging (MRI) have replaced conventional radiography in the study of many spinal conditions, it is essential to know when these techniques are indicated instead of or as complementary tests to radiography, which findings can be expected in different clinical settings, and their significance in the diagnosis of different spinal conditions. Proper use of CT and MRI in spinal disorders may facilitate diagnosis and management of spinal conditions. An adequate clinical approach, a good understanding of the pathological manifestations demonstrated by these imaging techniques and a comprehensive report based on a universally accepted nomenclature represent the indispensable tools to improve the diagnostic approach and the decision-making process in patients with spinal pain. Several guidelines are available to assist clinicians in ordering appropriate imaging techniques to achieve an accurate diagnosis and to ensure appropriate medical care that meets the efficacy and safety needs of patients. This article reviews the clinical indications of CT and MRI in different pathologic conditions affecting the spine, including congenital, traumatic, degenerative, inflammatory, infectious and tumor disorders, as well as their main imaging features. It is intended to be a pictorial guide to clinicians involved in the diagnosis and treatment of spinal disorders.
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Affiliation(s)
| | | | - Yì Xiáng J. Wáng
- Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - José Pablo Martínez Barbero
- Department of Radiology and Physical Medicine, Hospital Virgen de las Nieves, University of Granada, Granada, Spain
| | - Jade García Espinosa
- Department of Radiology and Physical Medicine, Hospital Virgen de las Nieves, University of Granada, Granada, Spain
| | - Alberto Martínez Martínez
- Department of Radiology and Physical Medicine, Hospital Virgen de las Nieves, University of Granada, Granada, Spain
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22
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Acute Left Chest Pain due to Spinal Hematoma. Am J Med 2022; 135:e119-e120. [PMID: 35202568 DOI: 10.1016/j.amjmed.2022.01.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 01/18/2022] [Indexed: 11/20/2022]
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23
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Imaging of Thoracolumbar Spine Traumas. Eur J Radiol 2022; 154:110343. [DOI: 10.1016/j.ejrad.2022.110343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 11/15/2022]
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24
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Goh WXT, Wong SBS, Chong APY, Yeap PM. Posterolateral migration of a sequestrated disc: magnetic resonance imaging findings demystified. Br J Hosp Med (Lond) 2022; 83:1-3. [DOI: 10.12968/hmed.2021.0415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Steven BS Wong
- Department of Radiology, Sengkang General Hospital, Singapore
| | - Angela PY Chong
- Department of Pathology, Sengkang General Hospital, Singapore
| | - Phey M Yeap
- Department of Radiology, Sengkang General Hospital, Singapore
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25
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Kidwell RL, Tan LA. Commentary: Symptomatic Epidural Hematoma After Elective Cervical Spine Surgery: Incidence, Timing, Risk Factors, and Associated Complications. Oper Neurosurg (Hagerstown) 2022; 22:e115-e116. [PMID: 35007237 DOI: 10.1227/ons.0000000000000070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/03/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Lee A Tan
- Department of Neurological Surgery, UCSF Medical Center, San Francisco, California; USA
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26
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CHAN CH, DESAI SR, HWANG NC. Cerebrospinal Fluid Drains: Risks in Contemporary Practice. J Cardiothorac Vasc Anesth 2022; 36:2685-2699. [DOI: 10.1053/j.jvca.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 01/03/2022] [Accepted: 01/12/2022] [Indexed: 11/11/2022]
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27
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Barr GQ, Mayer PL. Postoperative spinal subdural hygroma without incidental durotomy: illustrative cases. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21291. [PMID: 36061085 PMCID: PMC9435579 DOI: 10.3171/case21291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 07/29/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Spinal subdural hygroma (SSH) is a rare pathological entity occurring as a complication of spinal surgery. It is different from spinal subdural hematoma due to blunt trauma, anticoagulation therapy, spinal puncture, and rupture of vascular malformations.
OBSERVATIONS
The authors presented five patients with SSH who received decompression for lumbar stenosis. None had incidental durotomy. All presented postoperatively with unexpectedly severe symptoms, including back and leg pain and weakness. Postoperative magnetic resonance imaging (MRI) revealed SSH with a characteristic imaging finding termed the “flying bat” sign. Four patients underwent evacuation of SSH, with immediate and complete resolution of symptoms in three patients and improvement in one patient. One patient improved without additional surgery. At surgery, subdural collections were found to be xanthochromic fluid in three patients and plain cerebrospinal fluid (CSF) in one patient.
LESSONS
Unexpectedly severe back and leg pain and weakness after lumbar or thoracic spine surgery should raise suspicion of SSH. MRI and/or computed tomography myelography shows the characteristic findings termed the flying bat sign. Surgical evacuation is successful although spontaneous resolution can also occur. The authors hypothesized that SSH is due to CSF entering the subdural space from the subarachnoid space via a one-way valve effect.
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Affiliation(s)
- Garrett Q. Barr
- Florida State University College of Medicine, Department of Clinical Sciences, Sarasota, Florida
| | - Peter L. Mayer
- Florida State University College of Medicine, Department of Clinical Sciences, Sarasota, Florida
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28
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Rees MA, Squires JH, Coley BD, Hoehne B, Ho ML. Ultrasound of congenital spine anomalies. Pediatr Radiol 2021; 51:2442-2457. [PMID: 34532816 DOI: 10.1007/s00247-021-05178-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/07/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
Ultrasonography (US) is the first-line imaging modality for screening neonates and young infants with suspected spinal abnormalities. Whether performed for a suspicious congenital skin lesion, such as a lumbosacral tract or lipomatous mass, or abnormal neurological findings, US can help define spinal anatomy, characterize congenital spine malformations, and direct further work-up and management. The purpose of this article is to review the diagnostic imaging approach to infant spine US, including technique and indications, normal anatomy and variants with a focus on embryological origins, and classification and diagnosis of congenital spine malformations.
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Affiliation(s)
- Mitchell A Rees
- Department of Radiology, Nationwide Children's Hospital,, ED Building, 4th Floor, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Judy H Squires
- Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Brian D Coley
- Department of Radiology,, Cincinnati Children's Hospital Medical Cente,, Cincinnati, OH, USA.,Department of Radiology,, University of Cincinnati College of Medicine,, Cincinnati, OH, USA
| | - Brad Hoehne
- Department of Radiology, Nationwide Children's Hospital,, ED Building, 4th Floor, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Mai-Lan Ho
- Department of Radiology, Nationwide Children's Hospital,, ED Building, 4th Floor, 700 Children's Drive, Columbus, OH, 43205, USA
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29
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Reidy J, Mobbs R. Spinal Subdural Haematoma: a rare complication of spinal decompression surgery. World Neurosurg 2021; 158:114-117. [PMID: 34710577 DOI: 10.1016/j.wneu.2021.10.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Spinal Subdural Haematoma (SSH) is a rare and infrequently reported complication of hemilaminectomy, laminectomy and other spinal decompression surgeries. In this review, we aim to analyse the available literature for reported cases of SSH to better identify risk factors and presenting symptoms, as well as highlighting the importance in prompt investigation and management of SSH to prevent long-term morbidity and chronic neurological deficit. METHOD A review of the medical literature was undertaken using search terms hemilaminectomy OR laminectomy AND spinal subdural haematoma. All identified reports were screened for language, adult population and human studies. Report abstracts were screened for relevance to question, with SSH occurring postoperatively following hemilaminectomy or laminectomy included. Four reports were included in the review. CONCLUSION SSH is a rare, emergency condition with neurological deficit that can present as recurrent back pain and acute cauda equina post-operatively following hemilaminectomy and laminectomy procedures. Vigilance, early investigation and surgical evacuation is important in preventing short- and long-term morbidity. Further collation of data and analysis is required to better identify patients at high risk for developing SSH postoperatively.
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Affiliation(s)
- Joseph Reidy
- Department of Neurosurgery, Prince of Wales Hospital, Randwick, NSW, Australia; University of New South Wales, Randwick, NSW, Australia.
| | - Ralph Mobbs
- Department of Neurosurgery, Prince of Wales Hospital, Randwick, NSW, Australia; University of New South Wales, Randwick, NSW, Australia; NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
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30
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Winn A, Martin A, Castellon I, Sanchez A, Lavi ES, Munera F, Nunez D. Spine MRI: A Review of Commonly Encountered Emergent Conditions. Top Magn Reson Imaging 2021; 29:291-320. [PMID: 33264271 DOI: 10.1097/rmr.0000000000000261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Over the last 2 decades, the proliferation of magnetic resonance imaging (MRI) availability and continuous improvements in acquisition speeds have led to significantly increased MRI utilization across the health care system, and MRI studies are increasingly ordered in the emergent setting. Depending on the clinical presentation, MRI can yield vital diagnostic information not detectable with other imaging modalities. The aim of this text is to report on the up-to-date indications for MRI of the spine in the ED, and review the various MRI appearances of commonly encountered acute spine pathology, including traumatic injuries, acute non traumatic myelopathy, infection, neoplasia, degenerative disc disease, and postoperative complications. Imaging review will focus on the aspects of the disease process that are not readily resolved with other modalities.
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Affiliation(s)
- Aaron Winn
- University of Miami, Jackson Memorial Hospital, Miami, FL
| | - Adam Martin
- University of Miami, Jackson Memorial Hospital, Miami, FL
| | - Ivan Castellon
- University of Miami, Jackson Memorial Hospital, Miami, FL
| | - Allen Sanchez
- University of Miami, Jackson Memorial Hospital, Miami, FL
| | | | - Felipe Munera
- University of Miami, Jackson Memorial Hospital, Miami, FL
| | - Diego Nunez
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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31
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Agarwal V, Shah LM, Parsons MS, Boulter DJ, Cassidy RC, Hutchins TA, Jamlik-Omari Johnson, Kendi AT, Khan MA, Liebeskind DS, Moritani T, Ortiz AO, Reitman C, Shah VN, Snyder LA, Timpone VM, Corey AS. ACR Appropriateness Criteria® Myelopathy: 2021 Update. J Am Coll Radiol 2021; 18:S73-S82. [PMID: 33958120 DOI: 10.1016/j.jacr.2021.01.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 01/22/2023]
Abstract
Myelopathy is a clinical diagnosis with localization of the neurological findings to the spinal cord, rather than the brain or the peripheral nervous system, and then to a particular segment of the spinal cord. Myelopathy can be the result of primary intrinsic disorders of the spinal cord or from secondary conditions, which result in extrinsic compression of the spinal cord. While the causes of myelopathy may be multiple, the acuity of presentation and symptom onset frame a practical approach to the differential diagnosis. Imaging plays a crucial role in the evaluation of myelopathy with MRI the preferred modality. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Vikas Agarwal
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, Vice Chair of Education, Department of Radiology, University of Pittsburgh Medical Center, Program Director, Neuroradiology Fellowship, University of Pittsburgh Medical Center.
| | - Lubdha M Shah
- Panel Chair, University of Utah, Salt Lake City, Utah, Chair, Committee on Appropriateness Criteria, Co-Chair, Neurological Imaging Panel, member of the ACR Commission on Neuroradiology
| | - Matthew S Parsons
- Panel Vice-Chair, Mallinckrodt Institute of Radiology, Saint Louis, Missouri
| | | | - R Carter Cassidy
- UK Healthcare Spine and Total Joint Service, Lexington, Kentucky, American Academy of Orthopaedic Surgeons, Evidence Based Guideline Committee, North American Spine Society
| | | | | | - A Tuba Kendi
- Mayo Clinic, Rochester, Minnesota, Director of Nuclear Medicine Therapies, Mayo Clinic Rochester
| | | | - David S Liebeskind
- University of California Los Angeles, Los Angeles, California, American Academy of Neurology, President of SVIN
| | | | | | - Charles Reitman
- Medical University of South Carolina, Charleston, South Carolina, North American Spine Society
| | - Vinil N Shah
- University of California San Francisco, San Francisco, California
| | - Laura A Snyder
- Barrow Neurological Institute, Phoenix, Arizona, Neurosurgery expert
| | - Vincent M Timpone
- University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Amanda S Corey
- Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
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Abstract
PURPOSE OF REVIEW This article reviews the neuroimaging of disorders of the spinal cord and cauda equina, with a focus on MRI. An anatomic approach is used; diseases of the extradural, intradural-extramedullary, and intramedullary (parenchymal) compartments are considered, and both neoplastic and non-neoplastic conditions are covered. Differentiating imaging features are highlighted. RECENT FINDINGS Although T2-hyperintense signal abnormality of the spinal cord can have myriad etiologies, neuroimaging can provide specific diagnoses or considerably narrow the differential diagnosis in many cases. Intradural-extramedullary lesions compressing the spinal cord have a limited differential diagnosis and are usually benign; meningiomas and schwannomas are most common. Extradural lesions can often be specifically diagnosed. Disk herniations are the most commonly encountered mass of the epidural space. Cervical spondylotic myelopathy can cause a characteristic pattern of enhancement, which may be mistaken for an intrinsic myelopathy. A do-not-miss diagnosis of the extradural compartment is idiopathic spinal cord herniation, the appearance of which can overlap with arachnoid cysts and webs. Regarding intrinsic causes of myelopathy, the lesions of multiple sclerosis are characteristically short segment but can be confluent when multiple. Postcontrast MRI can be particularly helpful, including when attempting to differentiate the long-segment myelopathy of neurosarcoidosis and aquaporin-4 (AQP4)-IgG-seropositive neuromyelitis optica spectrum disorder (NMOSD) and when characterizing spinal cord tumors such as primary neoplasms and metastases. Spinal dural arteriovenous fistula is another do-not-miss diagnosis, with characteristic MRI features both precontrast and postcontrast. Tract-specific white matter involvement can be a clue for diseases such as subacute combined degeneration, paraneoplastic myelopathy, and radiation myelitis, whereas gray matter-specific involvement can suggest conditions such as cord infarct, viral myelitis, or myelin oligodendrocyte glycoprotein (MOG)-IgG associated disorder. SUMMARY Knowledge of the neuroimaging findings of the many causes of spinal cord and cauda equina dysfunction is critical for both neurologists and neuroradiologists. A structured approach to lesion compartmental location and imaging feature characterization is recommended.
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Vierunen RM, Koivikko MP, Siironen JO, Kerttula LI, Bensch FV. Post-traumatic spinal hematoma in ankylosing spondylitis. Emerg Radiol 2021; 28:601-611. [PMID: 33452963 DOI: 10.1007/s10140-020-01881-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/03/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of this study is to examine the incidence, location, and magnetic resonance imaging (MRI) features of spinal epidural hematoma (SEH) and spinal subdural hematoma (SSH) in post-traumatic ankylosing spondylitis (AS) patients. METHODS A total of 2256 consecutive referrals for urgent and emergency MRI scans of the spine over a period of eight years and nine months were manually reviewed for any mentions indicating axial ankylosis and post-traumatic spinal hematoma. We found 164 patients with ankylosed spines complicated by spinal fracture, of whom 32 had AS. Of the 132 excluded patients, 80 had diffuse idiopathic skeletal hyperostosis (DISH). The primary outcome was the presence of spinal hematoma, and the secondary outcome was spinal canal narrowing and spinal cord impingement. Two musculoskeletal radiologists and one fellow in musculoskeletal radiology reviewed the images for the presence of spinal hematoma and related signal characteristics, blinded to one another and initial reports. RESULTS Of 28 post-traumatic AS patients, 19 had SEHs and five had spinal SSHs. There was a statistically significant difference between Frankel grades before and after surgery in respect of neurological improvement (p = 0.008). Patients who had radiologically proven spinal cord impingement showed more severe neurological deficits (p = 0.012). Hematomas with T1 heterogeneity showed a significantly increased delay (p = 0.047) between injury and imaging, while other signal characteristics were only approximate. CONCLUSIONS Both SEH and SSH are common complications in post-traumatic AS patients. Patients benefit from surgery, but the relevance of spinal hematoma as a separate factor causing neurological deficit remains unclear.
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Affiliation(s)
- Riku M Vierunen
- HUS Diagnostic Center, HUS Medical Imaging Center, Department of Radiology, Töölö Trauma Center, Helsinki University Hospital, Topeliuksenkatu 5, FIN-00029, Helsinki, Finland.
| | - Mika P Koivikko
- HUS Diagnostic Center, HUS Medical Imaging Center, Department of Radiology, Töölö Trauma Center, Helsinki University Hospital, Topeliuksenkatu 5, FIN-00029, Helsinki, Finland
| | - Jari O Siironen
- Department of Neurosurgery, Töölö Trauma Center, Helsinki University Hospital, Topeliuksenkatu 5, FIN-00029, Helsinki, Finland
| | - Liisa I Kerttula
- HUS Diagnostic Center, HUS Medical Imaging Center, Department of Radiology, Töölö Trauma Center, Helsinki University Hospital, Topeliuksenkatu 5, FIN-00029, Helsinki, Finland
| | - Frank V Bensch
- HUS Diagnostic Center, HUS Medical Imaging Center, Department of Radiology, Töölö Trauma Center, Helsinki University Hospital, Topeliuksenkatu 5, FIN-00029, Helsinki, Finland
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Rahangdale R, Coburn J, Streib C. Spontaneous cervical epidural hematoma mimicking acute ischemic stroke. Neurology 2020; 95:496-497. [PMID: 32753432 DOI: 10.1212/wnl.0000000000010511] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Rahul Rahangdale
- From the Department of Neurology (R.R., C.S.), University of Minnesota, Minneapolis; and Division of Neuroradiology (J.C.), Midwest Radiology PA, St. Paul, MN.
| | - John Coburn
- From the Department of Neurology (R.R., C.S.), University of Minnesota, Minneapolis; and Division of Neuroradiology (J.C.), Midwest Radiology PA, St. Paul, MN
| | - Christopher Streib
- From the Department of Neurology (R.R., C.S.), University of Minnesota, Minneapolis; and Division of Neuroradiology (J.C.), Midwest Radiology PA, St. Paul, MN
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Laur O, Nandu H, Titelbaum DS, Nunez DB, Khurana B. Nontraumatic Spinal Cord Compression: MRI Primer for Emergency Department Radiologists. Radiographics 2020; 39:1862-1880. [PMID: 31589584 DOI: 10.1148/rg.2019190024] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The occurrence of acute myelopathy in a nontrauma setting constitutes a medical emergency for which spinal MRI is frequently ordered as the first step in the patient's workup. The emergency department radiologist should be familiar with the common differential diagnoses of acute myelopathy and be able to differentiate compressive from noncompressive causes. The degree of spinal cord compression and presence of an intramedullary T2-hyperintense signal suggestive of an acute cord edema are critical findings for subsequent urgent care such as surgical decompression. Importantly, a delay in diagnosis may lead to permanent disability. In the spinal canal, compressive myelopathy can be localized to the epidural, intradural extramedullary, or intramedullary anatomic spaces. Effacement of the epidural fat and the lesion's relation to the thecal sac help to distinguish an epidural lesion from an intradural lesion. Noncompressive myelopathy manifests as an intramedullary T2-hyperintense signal without an underlying mass and has a wide range of vascular, metabolic, inflammatory, infectious, and demyelinating causes with seemingly overlapping imaging appearances. The differential diagnosis can be refined by considering the location of the abnormal signal intensity within the cord, the longitudinal extent of the disease, and the clinical history and laboratory findings. Use of a compartmental spinal MRI approach in patients with suspected nontraumatic spinal cord injury helps to localize the abnormality to an epidural, intradural extramedullary, or intramedullary space, and when combined with clinical and laboratory findings, aids in refining the diagnosis and determining the appropriate surgical or nonsurgical management.Online supplemental material is available for this article.©RSNA, 2019.
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Affiliation(s)
- Olga Laur
- From the Departments of Radiology (O.L., D.B.N.), Neuroradiology (H.N., D.B.N.), and Emergency Radiology (B.K.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Department of Radiology, Shields Health Care, Brockton, Mass (D.S.T.)
| | - Hari Nandu
- From the Departments of Radiology (O.L., D.B.N.), Neuroradiology (H.N., D.B.N.), and Emergency Radiology (B.K.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Department of Radiology, Shields Health Care, Brockton, Mass (D.S.T.)
| | - David S Titelbaum
- From the Departments of Radiology (O.L., D.B.N.), Neuroradiology (H.N., D.B.N.), and Emergency Radiology (B.K.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Department of Radiology, Shields Health Care, Brockton, Mass (D.S.T.)
| | - Diego B Nunez
- From the Departments of Radiology (O.L., D.B.N.), Neuroradiology (H.N., D.B.N.), and Emergency Radiology (B.K.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Department of Radiology, Shields Health Care, Brockton, Mass (D.S.T.)
| | - Bharti Khurana
- From the Departments of Radiology (O.L., D.B.N.), Neuroradiology (H.N., D.B.N.), and Emergency Radiology (B.K.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Department of Radiology, Shields Health Care, Brockton, Mass (D.S.T.)
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36
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Romano N, Castaldi A. What's around the spinal cord? Imaging features of extramedullary diseases. Clin Imaging 2020; 60:109-122. [DOI: 10.1016/j.clinimag.2019.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/31/2019] [Accepted: 12/04/2019] [Indexed: 01/31/2023]
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Kilic M, Kilic B, Aydin MD, Yilmaz I, Yilmaz A, Yilmaz F, Kurt A, Nuri Kocak M. The casual association of cervical spinal cord ischemia and axonal degeneration in second motor neuron following subarachnoid hemorrhage: Experimental study. J Clin Neurosci 2019; 66:235-238. [PMID: 31153749 DOI: 10.1016/j.jocn.2019.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
Abstract
AIM Muscle abnormalities after spinal cord ischemia caused by subarachnoid hemorrhage (SAH) have not been explored for degenerative variations in the soma of second motor neurons of the spinal cord gray matter. This study aimed to investigate histopathological alterations in the gray matter and the role of peripheral nerves in SAH. MATERIAL AND METHODS Twenty-two rabbits were allocated in the control (Group I, n = 5), SHAM (Group II, n = 5), and research (Group III, n = 12) groups. Muscle weakness of the upper extremities innervated by radial nerves was evaluated at the initial day, and outcomes were recorded as control data. Re-measurements were done after injecting 0.5 ml of SF for SHAM and autolog artery blood inside craniocervical subarachnoid space for the study group. After 3 weeks, radial nerve roots, their ganglia, and segments of the spinal cord around C5-6 root entry zones were extracted bilaterally. Degenerated second motor neuron somas and the degenerated radial nerve motor axons at the intervertebral foramen were assessed. RESULTS The average degenerated soma intensity/mm3 at the C5-6 levels in the spinal cord was 2 ± 1/mm3, 13 ± 4/mm3, and 56 ± 10/mm3 for Groups I, II, and Group III. The average degenerated axon intensity of radial nerves was 3 ± 1/mm2, 34 ± 9/mm2, and 234 ± 78/mm2 for Groups I, II, and III. CONCLUSION Gray matter ischemia in the spinal cord may lead to axonal deterioration on equal levels at the peripheral nerves with advanced SAH. Detected or undetected spinal SAH should be considered an important factor on the etiology of second motor neuron diseases.
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Affiliation(s)
- Mustafa Kilic
- Department of Neurosurgery, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Betul Kilic
- Department of Pediatric Neurology, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey
| | - Mehmet Dumlu Aydin
- Department of Neurosurgery, Medical Faculty of Ataturk University, Erzurum, Turkey.
| | - Ilhan Yilmaz
- Department of Neurosurgery, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Adem Yilmaz
- Department of Neurosurgery, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Figen Yilmaz
- Department of Physical Therapy and Rehabilitation, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Ali Kurt
- Department of Pathology, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Mehmet Nuri Kocak
- Department of Neurosurgery, Medical Faculty of Ataturk University, Erzurum, Turkey
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Benyaich Z, Laghmari M, Lmejjati M, Aniba K, Ghannane H, Ait Benali S. Acute Lumbar Spinal Subdural Hematoma Inducing Paraplegia After Lumbar Spinal Manipulation: Case Report and Literature Review. World Neurosurg 2019; 128:182-185. [PMID: 31078801 DOI: 10.1016/j.wneu.2019.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 05/01/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Traumatic spinal subdural hematoma is an extremely rare occurrence that requires urgent investigation and most often prompt intervention. To our knowledge, this is the first reported case related to a spinal manipulative therapy. CASE DESCRIPTION This report describes a case of traumatic lumbar subdural hematoma after a spinal manipulative therapy without any predisposing factor. A 23-year-old man was admitted to the emergency department for partial cauda equina syndrome after a spinal manipulation performed by a physiotherapist. Magnetic resonance imaging showed an acute spinal subdural hematoma at L2-L3 level with cauda equina compression. The patient underwent an emergency L2 laminectomy with evacuation of the hematoma. He recovered completely his neurologic functions after 1 week. CONCLUSION Practitioners of spinal manipulations should be aware of spinal subdural hematoma as a possible complication. A rapid diagnosis with magnetic resonance imaging is mandatory, and emergency surgical decompression is usually the optimal treatment for spinal subdural hematomas with severe neurologic deficit.
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Affiliation(s)
- Zakariae Benyaich
- Department of Neurosurgery, University Hospital Center of Marrakech, FMPM, Cadi Ayyad University of Marrakech, Marrakech, Morocco.
| | - Mehdi Laghmari
- Department of Neurosurgery, University Hospital Center of Marrakech, FMPM, Cadi Ayyad University of Marrakech, Marrakech, Morocco
| | - Mohamed Lmejjati
- Department of Neurosurgery, University Hospital Center of Marrakech, FMPM, Cadi Ayyad University of Marrakech, Marrakech, Morocco
| | - Khalid Aniba
- Department of Neurosurgery, University Hospital Center of Marrakech, FMPM, Cadi Ayyad University of Marrakech, Marrakech, Morocco
| | - Houssine Ghannane
- Department of Neurosurgery, University Hospital Center of Marrakech, FMPM, Cadi Ayyad University of Marrakech, Marrakech, Morocco
| | - Said Ait Benali
- Department of Neurosurgery, University Hospital Center of Marrakech, FMPM, Cadi Ayyad University of Marrakech, Marrakech, Morocco
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Spontaneous Spinal Subdural Hematoma: Case Report of 2 Years' Clinical and Radiologic Findings. World Neurosurg 2019; 127:275-278. [PMID: 30986583 DOI: 10.1016/j.wneu.2019.04.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/07/2019] [Accepted: 04/08/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Spontaneous spinal subdural hematoma (SDH) is rare but leads to severe nerve compression. According to the symptoms, surgery decompression and conservative treatment are justified options. We present a spontaneous spinal SDH case treated by decompression surgery for the lumbar region and conservative observation for the thoracic region. A series of images of the disease course is available. CASE DESCRIPTION A 55-year-old woman without malignancy or coagulopathy history presented with progressive low back pain for the past 2 weeks. Progressive bilateral leg weakness happened 1 week ago. On the day she called for help, she presented with bilateral leg grade 2 muscle power and generalized back pain. There was no headache or meningeal sign. An absent bilateral knee reflex was found. Magnetic resonance imaging showed a space-occupying lesion at the T2-T6 and T12-L1 levels in the ventral and dorsal spinal canal, leading to cord compression. Due to rapid neurologic function deterioration, emergent T12-L1 laminectomy was performed. We found a T12-L1 tense dura sac with subdural hematoma ventral to the cord. Removal of the SDH was performed. T2-T6 levels were treated conservatively. She returned ambulant 1 week after operation. Magnetic resonance images at 3 months and 1 year later showed the SDH being absorbed and replaced by adhesive arachnoid cysts along the whole T and L spine. However, these lesions are asymptomatic for at least 2 years. CONCLUSIONS Surgical intervention is recommended in patients presenting with severe neurologic deficits. Conservative treatment is a reasonable option for asymptomatic patients.
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