Recovery after Delayed Surgery in a Case of Spinal Subdural Hematoma

Abstract

Spinal chronic subdural hematoma (SCSH) is a rare pathology usually associated with trauma or hematological alterations or is due to iatrogenic causes; rarely SCSH can be spontaneous. We report a case of a 79-year-old female who underwent a surgical evacuation of a spontaneous SCSH one year after diagnosis. She presented with a severe paraparesis and showed a considerable improvement in sensory-motor performances after surgery. The treatment of spontaneous SCSH is not well defined and universally accepted. Early surgery is mandatory in cases presenting with severe deficits. To the best of our knowledge, this is the first case showing a good outcome in a case of SCSH following a delayed surgery. In our opinion, an aggressive approach should be considered as a viable option in cases of spontaneous SCSH even after a lasting spinal cord compression.

Posttraumatic Acute Spinal Epidural Hematoma of the Dorsolumbar Region

“…3 Surgery is recommended in large-size lesions with neurological deficits to achieve good functional outcome. 1,3,22 In selected cases, a conservative management has also shown to be effective with good outcome. 7,18…”

10 Levels thoracic no-intrumented laminectomy for huge spontaneous spinal subdural hematoma removal. Report of the first case and literature review

“…In such cases, early decompressive laminectomy with evacuation of hematoma are considered the best treatment for SSDH, as performed in our case ( Table 1 ). On the other hand a case of a 79-year-old female undergone a surgical evacuation of a spontaneous SCSH one year after the diagnosis has been described [17] . She presented with a severe paraparesis and showed a considerable improvement in sensory-motor performances after surgery.…”

Expert’s Comment concerning Grand Rounds case entitled “Acute non-traumatic idiopathic spinal subdural hematoma: radiographic findings and surgical results with a literature review” by K. Kobayashi, S. Imagama, K. Ando, Y. Nishida, N. Ishiguro (Eur Spine J; 2017)

“…MR findings of SSDH vary based on the clot, age, and oxygenation: within the first 24 h after symptom onset, the hematoma shows isointensity on T1WI and hyperintensity on T2WI. On the other hand, it is fair to remember the case of a 79-year-old female who undergone a surgical evacuation of a spontaneous SSDH 1 year after the diagnosis [3]. After injection of gadolinium, peripheral enhancement of the lesion is found frequently; otherwise, the central enhancement is found only occasionally.…”

“…Spontaneous idiopathic acute spinal subdural hematoma (SSDH) is a rare cause of acute back pain followed by signs and symptoms of nerve root and/or spinal cord compression. In idiopathic SSDHs, therapy is limited to the hematoma management, as there is no underlying pathology to face with surgically [3,4]. The true etiology of SSDHs still remains unknown, but associations with some predisposing conditions, such as coagulopathies, blood dyscrasias, and arteriovenous malformations, are reported.…”

“…Non-operative treatment for SSDH may be justified in the presence of minimal neurologic deficits; otherwise, early decompressive laminectomy along with evacuation of hematoma are considered the treatment of choice in the presence of major deficits; moreover, it is also known that patients with paraplegia and bowel and bladder dysfunction present the poorest prognosis regardless of surgical or conservative treatment [2,3]. MR findings of SSDH vary based on the clot, age, and oxygenation: within the first 24 h after symptom onset, the hematoma shows isointensity on T1WI and hyperintensity on T2WI.…”