Spinal subarachnoid hematomas: our experience and literature review

Abstract

MRI and CT are not usually diagnostic because they are not able to differentiate between a subarachnoid lesion and a subdural one. However, diagnosis may be possible when these investigations detect the CSF or the contrast medium surrounding the hematoma. Although the risks of producing spinal subarachnoid hematoma as a result of LP are remote, this is, in fact, the primary cause in patients with coagulopathies. The results of treatment depend on the patient's initial neurological condition, the severity of any concomitant pathologies, the position of the hematoma and the eventual association of a subdural hematoma.

Prospective assessment of concomitant lumbar and chronic subdural hematoma: is migration from the intracranial space involved in their manifestation?

“…Although earlier studies reported that lumbar SDH arose after direct trauma to the hip or lumbar region, 6,19 we suspected migration from the intracranial to the lum bar area. To identify the rate of coincidental SDH and to remove the bias of their attribution to trauma to the hip or lumbar region, we compared their rate in patients who had sustained head trauma only with the rate in patients with multiple traumas.…”

“…Its pathogenesis has been considered secondary to coagulopathies (including SDH arising after anticoagulant therapy), lumbar punc ture, vascular malformations, traumatic injuries, low CSF pressure, and idiopathic causes, factors that may be pres ent singly or in various combinations. 6,15,19 No etiologic factor for bleeding was identified in 17.3%-29.7% of these patients, and most spinal SDHs were observed in patients with vascular malformations and in patients treated by anticoagulant therapy, although this therapy alone is not thought to elicit spinal hemorrhage. 6,19 Diagnostic MRI studies show the size and extent of the hemorrhage and its relationship to the spinal cord.…”

“…Lee et al 24 reported that their 4 patients with mild symptoms of spinal SDH who were placed under observation or underwent lumbar spinal puncture and/or drainage of the hematoma recovered completely within 3 weeks without permanent neurological deficits. Domeni cucci et al 6 documented a good outcome in 29 (94%) of 31 patients with spinal SDH whose neurological status at the time of admission was satisfactory and in 3 (16%) of 19 patients who had severe neurological deficits. In the presence of acute deterioration and severe neurological deficits, emergency surgical decompression was recom mended as the best treatment option.…”

“…This weakens the case for migration from the intracranial to the lumbar space. Others 6,19 have suggested that lumbar SDH is the result of direct trauma to the hip or lumbar area. To identify the incidence of concomitant intracranial and lumbar SDH, we separately evaluated patients with head trauma only and those with multiple traumas.…”

“…In the presence of acute deterioration and severe neurological deficits, emergency surgical decompression was recom mended as the best treatment option. 6,19 Conservative management is appropriate in patients with mild neuro logical deficits and progressive improvement in the early period. Lastly, in some patients with stable deficits whose hematomas are located dorsally with moderate extension into the lumbosacral area and no bleeding diathesis, per cutaneous drainage may be the best treatment choice.…”