Idiopathic cervical spinal subdural haematoma: a case report and literature review

Abstract

This report describes a case of idiopathic cervical spinal subdural haematoma (SSDH) in which the haematoma was spontaneously absorbed without any treatment. A 68-year-old male patient presented with persistent neck pain and no obvious cause. Magnetic resonance imaging (MRI) revealed a space-occupying lesion at the C4–T1 levels. The lesion was initially misdiagnosed as a tumour. An operation was arranged to remove the tumour, but a preoperative computed tomography scan showed no obvious abnormal soft tissue density in the cervical spinal canal. Repeat enhanced MRI showed degeneration of the cervical vertebrae, but no obvious abnormal soft tissue density and no obvious enhanced signals in the cervical spinal canal. Spontaneous resolution of an idiopathic cervical SSDH was considered. Idiopathic cervical SSDH without obvious neurological symptoms are difficult to diagnose, so suspected cases should be carefully monitored. If the neurological symptoms grow progressively more debilitating with time, emergency surgery might need to be considered. To avoid unnecessary surgery, conservative management should be an option for patients with minimal neurological deficits and re-examination with MRI could be the best way to observe the dynamic changes taking place in the idiopathic cervical SSDH.

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

“…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.…”

“…[ 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. [ 3 , 14 , 16 , 19 , 20 ] Previously, SSDH was clinically classified in four levels; grade 0 = normal, I = weakness, pain and/ or mild hypoesthesia, II = invalidating paresis and level of hypoesthesia, and III = abolished motor and sensory capacities.…”

“…[ 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.…”

“…[ 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.…”

Acute Spontaneous Spinal Subdural Hematoma: A Case Report

“…The source of bleeding is usually venous, and symptoms can progress over days. Time to intervention is crucial, especially in neurologically unstable patients [ 1 ]. Laminectomy and evacuation of the blood are vital to relieve the compression and avoid permanent loss of neurologic function.…”