Acute Cervical Spinal Subdural Hematoma Not Related to Head Injury

Abstract

We report an extremely rare case of traumatic cervical spinal subdural hematoma not related to intracranial injury. There has been no report on traumatic cervical spinal subdrual hematoma not related to intracranial injury. A 27-year-old female patient was admitted to our emergency room due to severe neck pain and right arm motor weakness after car collision. On admission, she presented with complete monoplegia and hypoesthesia of right arm. Magnetic resonance imaging (MRI) revealed subdural hematoma compressing spinal cord. Lumbar cerebrospinal fluid (CSF) analysis revealed 210,000 red blood cells/mm(3). She was managed conservatively by administrations of steroid pulse therapy and CSF drainage. Her muscle power of right arm improved to a Grade III 16 days after admission. Follow-up MRI taken 16th days after admission revealed almost complete resolution of the hematoma. Here, the authors report a traumatic cervical spinal SDH not associated with intracranial injury.

Spontaneous Resolution of Non-traumatic Cervical Spinal Subdural Hematoma Presenting Acute Hemiparesis: A Case Report

“…Acute spinal SDH is a rare pathological entity that is caused by compression of the spinal cord or cauda equina 1) . Although there is no evidence of any underlying causes and this type of hematoma appears spontaneously, several authors have reported that hematological disorders, anticoagulant therapy, spinal puncture, or traumatic brain injury predispose individuals to developing spinal SDH 3 , 5) . Acute spontaneous SDHs appearing in the absence these predisposing conditions are very rarely reported and are frequently located in the thoracic spine 2) .…”

“…Moreover, relatively larger and more vascularized epidural fatty tissues are present and the spinal dura does not adhere to bone. Thus, spinal epidural hematoma occurs more frequently than spinal SDH 5) .…”

“…However, it is difficult to differentiate between a subdural and epidural hematoma on the spine in some cases. In such instances, lumbar tapping is a useful diagnostic tool to determine the exact location of the hematoma 5) . It is widely accepted that prompt surgical evacuation should be performed before permanent irreversible damage to the spinal cord occurs when severe neurological symptoms or clinical worsening are observed.…”

“…Spinal subdural hematoma (SDH) is a rare clinical entity that frequently occurs in the thoracic regions of the spine. This condition can be caused by major or minor trauma and iatrogenic causes such as ones resulting from spinal puncture performed for diagnostic- or anesthetic-related purposes 2 , 5) . It can also occur spontaneously in patients with coagulation abnormalities, underlying neoplasm, or arteriovenous malformation 7) .…”

Kardiyovasküler Tedavi Sırasında Gelışen Üç Spinal Hematom Olgusu

“…In addition to sudden-onset of severe back pain radiating to paraparesis and quadriparesis, varying degrees of motor and sensory deficits are particularly among the typical symptoms of spinal hematomas. The progressive motor deficit that develops following the pain may manifest itself as quadriplegia, quadriparesis, paraplegia, paraparesis, sensorial deficit, or cauda equina syndrome (4)(5)(6)8,11,12). The clinical findings may be hemiparesis or hemihypesthesia due to unilateral cord compression (5).…”