Acute Lumbar Spinal Subdural Hematoma Inducing Paraplegia After Lumbar Spinal Manipulation: Case Report and Literature Review

Benyaich, Zakariae; Laghmari, Mehdi; Lmejjati, M.; Aniba, K.; Ghannane, H.; Benali, S. Aït

doi:10.1016/j.wneu.2019.05.002

Cited by 8 publications

(15 citation statements)

References 23 publications

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“…SSDH is a rare, uncommon condition characterized by a sudden onset of headache, back pain, or radicular pain and has rapid progression of spinal cord compression symptoms such as sensorimotor change, autonomous function, and neurogenic bladder . [ 3 , 8 , 11 , 12 , 16 , 19 , 20 ] Early diagnosis of SSDH is essential, because the compression can compromise the spinal cord and/or roots of the cauda equina, resulting in permanent neurologic deficit or death. [ 6 , 20 ] SSDH usually presents in between 45 and 60 years of life, with a slight female predominance, predominantly in the thoracic spine, followed by the cervicothoracic and thoracolumbar spine.…”

Section: Discussionmentioning

confidence: 99%

“…It has been described that approximately 70% of COVID-19 treated patients developed coagulation abnormalities and autopsy revealed almost 58% of patients died due to venous thrombosis and pulmonary embolism. [ 1 - 3 , 5 ] COVID-19-associated coagulopathy presents with prominent elevation of D-dimer and fibrin/fibrinogen-degradation products, whereas abnormalities in prothrombin time, partial thromboplastin time, and platelet counts are relatively uncommon in initial presentations. [ 5 ]…”

Section: Discussionmentioning

confidence: 99%

“…When symptoms suggest a spinal cord compression due to a spinal hematoma, MRI appears to be the gold standard and the modality of choice, providing information on the exact level of the hematoma, degree of nervous structures compression, and consequence for the spinal cord. [ 3 , 12 , 19 ] SSDH diagnosis is challenging, particularly in idiopathic cases, sometimes resulting in delayed management; the time from the onset of hemorrhage to the clinical presentation can vary from a few hours to a few months. [ 19 , 20 ] Due to the few reported cases, the management of SSDH is not well standardized.…”

Section: Discussionmentioning

confidence: 99%

“…[ 3 , 6 , 12 , 16 , 18 - 20 ] SSDH leads to spinal cord or cauda equine compression, with symptoms varying from mild-to-severe neurological deficit, causing devastating neurological consequences, even death. [ 3 , 14 , 16 , 17 ] SSDH could occur as a consequence of posttraumatic, iatrogenic, or spontaneous, that is, idiopathic causes, including underlying arteriovenous malformations or tumors and coagulation disorder. [ 3 , 6 , 12 , 14 , 16 , 20 ] In spontaneous cases, diagnosis may be frequently delayed.…”

Section: Introductionmentioning

confidence: 99%

“…[ 3 , 14 , 16 , 17 ] SSDH could occur as a consequence of posttraumatic, iatrogenic, or spontaneous, that is, idiopathic causes, including underlying arteriovenous malformations or tumors and coagulation disorder. [ 3 , 6 , 12 , 14 , 16 , 20 ] In spontaneous cases, diagnosis may be frequently delayed. [ 19 , 20 ] Taken into account the SSDH rarity, it is quite difficult to establish standardized treatment.…”

Section: Introductionmentioning

confidence: 99%

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Spontaneous spinal subdural hematoma in COVID-19 patient: Croatian national COVID hospital experience

Dlaka

Vavro

Romić

et al. 2022

Surgical Neurology International

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Background: Spontaneous spinal subdural hematoma (SSDH) is a rare condition and causes of acute spinal cord compression, with symptoms varying from mild to severe neurological deficit. SSDH could occur as a consequence of posttraumatic, iatrogenic, or spontaneous causes, including underlying arteriovenous malformations, tumors, or coagulation disorder. Due to its rarity, it is difficult to establish standardized treatment. We present a rare case of SSDH in COVID-19 patient and course of treatment in COVID hospital. Case Description: A 71-year-old female patient was admitted due to instability, weakness of the left leg, and intensive pain in the upper part of thoracic spine as well as mild respiratory symptoms of COVID-19. She was not on pronounced anticoagulant therapy and her coagulogram at admission was within normal range. MRI revealed acute subdural hematoma at the level C VII to Th III compressing the spinal cord. The patient underwent a decompressive Th I and Th II laminectomy and hematoma evacuation. Post-operative MRI revealed a satisfactory decompression and re-expansion of the spinal cord. COVID-19 symptoms remained mild. Conclusion: SSDH represents a neurological emergency, possibly leading to significant deficit and requires urgent recognition and treatment. One of the main difficulties when diagnosing is to consider such condition when there is no history of anticoagulant treatment or previous trauma. Since high incidence of coagulation abnormalities and thromboembolic events was described COVID-19 patients, when considering the pathology of the central nervous system, the bleeding within it due to COVID-19 should be taken into account, in both brain and spine.

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