Lumbosacral Subdural Hematoma-Case Report-

Abstract

An 18-year-old man presented with a rare spinal subdural hematoma (SSH) manifesting as headache, which developed following diving into the sea the day before. Computed tomography of the head revealed no abnormality. His headache persisted followed by neck stiffness and mild lumbago. He came to see us 6 days after the first visit. He underwent lumbar puncture to eliminate the possibility of meningitis. The cerebrospinal fluid showed xanthochromia. Cerebral angiography showed no abnormality. Magnetic resonance imaging of the spine revealed lumbosacral subdural hematoma. The hematoma and his symptoms regressed spontaneously during several weeks of conservative treatment. A sharp increase in intraabdominal and/or intrathoracic pressures following diving may have caused the bleeding. Headache may be an initial symptom associated with subarachnoid hemorrhage concomitant with SSH. Delayed progression of lumbosacral SSH must be considered if the patient complains of lumbago following minor trauma.

Spontaneous spinal subarachnoid hemorrhage after severe coughing: a case report

“…To the best of our knowledge, only 20 individual cases of spontaneous SSH, including our patient without any apparent source of bleeding, have been reported [1-6,8-15]. The paroxysmal onset of severe back pain and headache is observed in 11 of 20 spontaneous SSH cases, including our patient [2-4,6,8-10,12,14,15]. Consciousness disturbance was observed in three of the 20 cases [3,10].…”

“…Consciousness disturbance was observed in three of the 20 cases [3,10]. The circumstances at the time of onset of symptoms include eating, bending the head, scuba diving, having sexual intercourse, defecating, receiving the recoil of a shotgun, and jumping into the sea [1-3,5,10,12,13,15]. To the best of our knowledge, there have been no reported cases of SSH that developed after severe coughing.…”

Spontaneous subdural hematoma of the thoracolumbar region with massive recurrent bleed

“…It is difficult to evacuate the hematoma completely as often has extended and elongated configuration 21. Recently many reports have pointed out the possibility of spontaneous resolution of the SSDH172223 and conservative treatment plays a role in the management of SSDH with stable neurological status 424. The neurological recovery depends on the duration of symptoms, severity of compression, and the aggressiveness of surgical intervention in symptomatic patients 2526.…”

A rare, high cervical traumatic spinal subdural hematoma

“…6,15,16 Headaches are also described as an initial symptom, especially in lumbar SSDH. Radicular pain may also exist, especially in lumbosacral hematomas.…”

“…48 The formation of a spinal subdural space may result from the destruction of these neurothelial cells. Mashiko et al, 16 who described an 18-year-old man with lumbar SSDH who presented with meningism and lower back pain that appeared 6 days after diving, hypothesized that the SSDH was caused by an acute increase in the patient's intrathoracic pressure after diving. A sudden and intense rise in thoracic and/or abdominal pressure may increase the pressure within intraspinal vessels, particularly the valveless radiculomedullary veins that cross the subdural and the subarachnoid spaces.…”