We report a case of spontaneous spinal subdural hematoma that was not associated with a coagulation abnormality. A 72 year old woman was admitted to our department because of sudden back pain and motor weakness in both legs. There was no history of trauma, iatrogenic factor, or use of anticoagulant agents, and no laboratory evidence of a bleeding diathesis. Magnetic resonance imaging MRI showed a longitudinal, space occupying lesion extending from C7 to T3 in the left posterolateral spinal canal. Based on the clinical and MRI findings, a cervicothoracic spinal epidural hematoma was diagnosed. The patient underwent a left hemilaminectomy from C6 through T4. A subdural hematoma was identified and evacuated. Angiography revealed no vascular malformations. Postoperatively, the patient had significant neurological recovery, and was discharged on foot 6 weeks after the surgery. It is important to consider the possibility of this clinical entity in patients who present with acute signs of cord compression, as a prompt diagnosis is essential for the successful treatment of spinal subdural hematoma. Differentiation of spontaneous spinal subdural hematoma from spinal epidural hematoma may be difficult and warrants close inspection of the MR images.
Objective: Unidentified fever, headache, and gastrointestinal symptoms after endosaccular coil embolization are occasionally observed in patients with unruptured cerebral aneurysms. We defined these symptoms as post coiling syndrome (PCS) and analyzed the clinical risk factors involved.
Methods:We applied the PCS diagnostic criteria based on the scoring of symptoms, which include fever, headache, nausea, and/or vomiting. Thirty-six consecutive patients were included in this retrospective study. Systematic follow-up included clinical and blood examinations.Results: Based on our criteria, 11 of 36 patients were diagnosed with PCS. Between patients in the PCS group and patients in the non-PCS group, we recognized significant differences in age (63.4 ± 12.5 vs. 53.8 ± 12.9, respectively; p <0.029) as patient background and in aneurysmal diameter (9.96 ± 4.24 vs. 6.48 ± 3.06, respectively; p <0.049), aneurysmal volume (242 ± 254 vs. 87.9 ± 70.1, respectively; p <0.015), total coil length (122 ± 106 vs. 39.1 ± 25.7, respectively; p <0.0021), and volume embolization ratio as aneurysmal data (41.9 ± 8.1 vs. 30.7 ± 8.5, respectively; p <0.0019). In addition, we recognized a significant difference in postoperative leukocytosis as an inflammatory factor.
Conclusions:Patient age, aneurysmal diameter, aneurysmal volume, total coil length, and volume embolization may enable the prediction of PCS.
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