Subacute spinal subdural hematoma after spontaneous resolution of cranial subdural hematoma: causal relationship or coincidence?

Case report

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✓ 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.

Article Information

Address reprint requests to: Giuseppe Lanzino, M.D., Department of Neurosurgery, University of Illinois College of Medicine at Peoria, 530 Glen Oak Avenue, Peoria, Illinois 61637. email: lanzino@uic.edu.

© AANS, except where prohibited by US copyright law.

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Figures

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    Postinjury noncontrast brain CT scans revealing SDH with marked midline shift.

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    Noncontrast brain CT scans obtained 12 hours after initial scans, demonstrating almost complete resolution of the convexity hematoma and layering of blood along the tentorium.

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    Neuroimages of the lumbosacral spine, acquired 10 days after the original injury. Left: Axial T1-weighted MR image revealing a large SDH compressing the dural sac at L5—S1. Right: Sagittal T2-weighted MR image demonstrating the large SDH extending from L-4 to S-2.

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    Postoperative neuroimages obtained several hours after drainage of the spinal SDH. Left: Axial T2-weighted MR image demonstrating almost complete resolution of the hematoma at the same level as that in Fig. 3 left. Right: Sagittal T2-weighted image confirming almost complete drainage.

References

1.

Abla AAOh MY: Spinal chronic subdural hematoma. Neurosurg Clin N Am 11:4654712000Abla AA Oh MY: Spinal chronic subdural hematoma. Neurosurg Clin N Am 11:465–471 2000

2.

Bernsen RAHoogenraad TU: A spinal haematoma occurring in the subarachnoid as well as in the subdural space in a patient treated with anticoagulants. Clin Neurol Neurosurg 94:35371992Bernsen RA Hoogenraad TU: A spinal haematoma occurring in the subarachnoid as well as in the subdural space in a patient treated with anticoagulants. Clin Neurol Neurosurg 94:35–37 1992

3.

Chen HJLiang CLLu Ket al: Cauda equina syndrome caused by delayed traumatic spinal subdural hematoma. Injury 32:5055072001Chen HJ Liang CL Lu K et al: Cauda equina syndrome caused by delayed traumatic spinal subdural hematoma. Injury 32:505–507 2001

4.

Gambacorta DReale FDe Falco D: Spontaneous chronic subarachnoid hematoma. Report of a case and review of the literature. Spine 12:7167181987Gambacorta D Reale F De Falco D: Spontaneous chronic subarachnoid hematoma. Report of a case and review of the literature. Spine 12:716–718 1987

5.

Hung KSLui CCWang CHet al: Traumatic spinal subdural hematoma with spontaneous resolution. Spine 27:5345382002Hung KS Lui CC Wang CH et al: Traumatic spinal subdural hematoma with spontaneous resolution. Spine 27:534–538 2002

6.

Inamasu JNakamura YSaito Ret al: Rapid resolution of traumatic acute subdural hematoma by redistribution. Am J Emerg Med 20:3763772002Inamasu J Nakamura Y Saito R et al: Rapid resolution of traumatic acute subdural hematoma by redistribution. Am J Emerg Med 20:376–377 2002

7.

Juvonen TTervonen OUkkola Vet al: Widespread posttraumatic spinal subdural hematoma—imaging findings with spontaneous resolution: case report. J Trauma 36:2622641994Juvonen T Tervonen O Ukkola V et al: Widespread posttraumatic spinal subdural hematoma—imaging findings with spontaneous resolution: case report. J Trauma 36:262–264 1994

8.

Kotwica ZStawowy APolis L: Spinal chronic subdural haematoma in a 7-year old girl. Eur J Pediatr 148:7797801989Kotwica Z Stawowy A Polis L: Spinal chronic subdural haematoma in a 7-year old girl. Eur J Pediatr 148:779–780 1989

9.

Kuroiwa TTanabe HTakatsuka Het al: Rapid spontaneous resolution of acute extradural and subdural hematomas. Case report. J Neurosurg 78:1261281993Kuroiwa T Tanabe H Takatsuka H et al: Rapid spontaneous resolution of acute extradural and subdural hematomas. Case report. J Neurosurg 78:126–128 1993

10.

Leber KAPendl GKogler Set al: Simultaneous spinal and intracranial chronic subdural hematoma. Case illustration. J Neurosurg 87:644001997Leber KA Pendl G Kogler S et al: Simultaneous spinal and intracranial chronic subdural hematoma. Case illustration. J Neurosurg 87:644–00 1997

11.

Lee JIHong SCShin HJet al: Traumatic spinal subdural hematoma: rapid resolution after repeated lumbar spinal puncture and drainage. J Trauma 40:6546551996Lee JI Hong SC Shin HJ et al: Traumatic spinal subdural hematoma: rapid resolution after repeated lumbar spinal puncture and drainage. J Trauma 40:654–655 1996

12.

Matsuyama TShimomura TOkumura Yet al: Rapid resolution of symptomatic acute subdural hematoma: case report. Surg Neurol 48:1931961997Matsuyama T Shimomura T Okumura Y et al: Rapid resolution of symptomatic acute subdural hematoma: case report. Surg Neurol 48:193–196 1997

13.

Nagao TNobuhiko AMizutani Het al: Acute subdural hematoma with rapid resolution in infancy: case report. Neurosurgery 19:4654671986Nagao T Nobuhiko A Mizutani H et al: Acute subdural hematoma with rapid resolution in infancy: case report. Neurosurgery 19:465–467 1986

14.

Nicholas DSWeller RO: The fine anatomy of the human spinal meninges. A light and scanning electron microscopy study. J Neurosurg 69:2762821988Nicholas DS Weller RO: The fine anatomy of the human spinal meninges. A light and scanning electron microscopy study. J Neurosurg 69:276–282 1988

15.

Paredes ESDKishore PRSWard JD: Cervical spinal subdural hematoma. Surg Neurol 15:4774791981Paredes ESD Kishore PRS Ward JD: Cervical spinal subdural hematoma. Surg Neurol 15:477–479 1981

16.

Polman CHGijsbers CJHeimans JJet al: Rapid spontaneous resolution of an acute subdural hematoma. Neurosurgery 19:4464481986Polman CH Gijsbers CJ Heimans JJ et al: Rapid spontaneous resolution of an acute subdural hematoma. Neurosurgery 19:446–448 1986

17.

Rader JP: Chronic subdural hematoma of the spinal cord. N Engl J Med 253:3743761955Rader JP: Chronic subdural hematoma of the spinal cord. N Engl J Med 253:374–376 1955

18.

Reina AMCasasola DLOLopez Aet al: The origin of the spinal subdural space: Ultrastructure findings. Anesth Analg 94:9919952002Reina AM Casasola DLO Lopez A et al: The origin of the spinal subdural space: Ultrastructure findings. Anesth Analg 94:991–995 2002

19.

Russel NABenoit BG: Spinal subdural hematoma. A review. Surg Neurol 20:1331371983Russel NA Benoit BG: Spinal subdural hematoma. A review. Surg Neurol 20:133–137 1983

20.

Stewart DH JrWatkins ES: Spinal cord compression by chronic subdural hematoma. Case report. J Neurosurg 31:80821969Stewart DH Jr Watkins ES: Spinal cord compression by chronic subdural hematoma. Case report. J Neurosurg 31:80–82 1969

21.

Zilkha ANicoletti JM: Acute spinal subdural hematoma. Case report. J Neurosurg 41:6276301974Zilkha A Nicoletti JM: Acute spinal subdural hematoma. Case report. J Neurosurg 41:627–630 1974

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