Spinal Subdural and Epidural Haematomas: Diagnostic and Therapeutic Aspects in Acute and Subacute Cases

Küker, Wilhelm; Thiex, Ruth; Friese, Sigrid; Freudenstein, Dirk; Reinges, M. H. T.; Ernemann, Ulrike; Kringes, T.; Skalej, Martin

doi:10.1007/s007010070092

Cited by 99 publications

(40 citation statements)

References 17 publications

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“…Axial MRI cuts generally allow for identification of the dura and appreciation of a semi-circular and generally ventral fluid collection, bright on T2 though relatively isointense to CSF in the setting of SSH (17). SSH crowds the cauda equina roots, though perhaps without the significant displacement common to epidural compression, generally most significant dorsal to the thecal sac (18).…”

Section: Discussionmentioning

confidence: 99%

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Spinal subdural hematoma: a rare case of spinal subdural hematoma complicating routine, minimally invasive lumbar discectomy and decompression and relevant literature review

et al. 2017

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We present a case of apparently uncomplicated lumbar decompression and discectomy with delayed postoperative neurological deterioration secondary to subdural hematoma at the thoracolumbar level of the spinal cord. Previously described subdural hematomas have occurred spontaneously or related to iatrogenic Case Report Case presentationA 76-year-old presented with a 9-month history of radiating lower extremity pain, left worse than right, with minimal back pain. The symptoms onset acutely after lifting a heavy ice box. He reported intermittent paresthesias in bilateral L4−L5 distributions without any complaint of weakness. Symptoms worsened with extension, upright posture and Valsalva maneuver and improved with forward flexion. He had no prior spine surgery. He had 3 separate transforaminal epidural steroid injections containing anesthetic and cortisone directed at the left L3-4 and L4-5 space, the most recent of which was 1 month prior to presentation. With all injections he noted marked improvement during the anesthetic phase but no durable effect. His past medical history was significant for coronary artery disease status post remote stenting and peripheral arterial disease status post remote carotid endarterectomy. Aside from fish oil and daily low dose aspirin, he was not on anticoagulant medications.On exam, he had 5/5 motor strength in his bilateral lower extremities with no fixed, focal sensory deficits. His lower extremity reflexes were diffusely diminished though

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Section: Discussionmentioning

confidence: 99%

“…SSH crowds the cauda equina roots, though perhaps without the significant displacement common to epidural compression, generally most significant dorsal to the thecal sac (18). Enhancement with gadolinium contrast is variably reported (17,19,20), though may be useful in making the radiographic distinction between hygroma and effusion (21).…”

Section: Discussionmentioning

confidence: 99%

Spinal subdural hematoma: a rare case of spinal subdural hematoma complicating routine, minimally invasive lumbar discectomy and decompression and relevant literature review

et al. 2017

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“…Whereas demyelinating disorders of the medullary cord are rarely painful, few neoplastic conditions are as rapidly progressive as medullary cord infarction. However, spinal epidural or subdural haematomas, which may occur spontaneously, have to be excluded by MRI [3].…”

Section: Discussionmentioning

confidence: 99%

Diffusion-weighted MRI of spinal cord infarction

et al. 2004

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Infarction is a rare cause of spinal cord dysfunction. Whereas diffusion-weighted (DW) MRI has been established as a highly sensitive technique for assessing acute cerebral ischemia, its role in spinal cord infarction remains to be determined. The purpose of this study is to present the signal characteristics of acute spinal cord ischemia using DWMRI within the first two days and after one week. MRI including DW imaging (DWI) was performed in three patients with acute spinal cord dysfunction 8, 12 and 30 hours after the onset of symptoms and repeated after one week in two patients. Two initial scans included EPI DW sequences in transverse and sagittal orientation. The remaining examinations were performed with an optimised high-spatial resolution DWI sequence in the transverse plane. The diagnosis of spinal cord ischemia was established by imaging, clinical history and CSF analysis. T2 signal abnormality and restricted diffusion was demonstrated in all initial examinations. Transverse DW sequences had the highest sensitivity. The spinal infarctions were mainly located in the centre of the spinal cord and the grey matter. Contrast enhancement was absent. After one week, the restricted diffusion had normalised (pseudo normalisation) whereas the T2 signal changes had become more prominent. Restricted diffusion in the course of spinal cord ischemic infarction can be demonstrated using DW-MRI. Whereas a diffusion abnormality can be found after few hours, it does not last for longer than one week. At this time, the establishment of the diagnosis has to rely mainly on T2-weighted images with additional post contrast T1-weighted images being useful.

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“…7) Because of the semicircular distribution of the subdural hematoma, the imaging finding is less conspicuous with caudocranial extension than epidural hematoma. 9) Subdural hematoma is usually located ventrally, 4) which might be due to the tight attachment of the dura to the posterior longitudinal ligament. In our case, CT revealed spinal hematoma on the ventral side in the canal with relatively long caudocranial extension.…”

Section: Discussionmentioning

confidence: 99%

Development of Cervical Subarachnoid Hematoma Following Coronal Artery Stenting for Angina Pectoris -Case Report-

Yasuhara

Miyoshi

Date

2011

Neurol. Med. Chir.(Tokyo)

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A 78-year-old man presented with a rare massive subarachnoid hematoma (SAH) in the cervical spine after coronary stenting for angina pectoris. Chest pain and electrocardiographic changes were resolved after administration of coronary dilator and coronary stenting, but shoulder pain persisted. At 6 hours after stenting, left hemiparesis was found with deteriorated shoulder pain. Computed tomography and magnetic resonance imaging revealed massive SAH in the cervical spine. Emergent hematoma evacuation with laminoplasty was performed because of rapid progression of the hemiparesis and pain. The hemiparesis was ameliorated after surgery. Spinal hematoma should be considered in the differential diagnosis in patients receiving anti-platelet or anti-coagulant drugs with rapid progression of pain.

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Spinal Subdural and Epidural Haematomas: Diagnostic and Therapeutic Aspects in Acute and Subacute Cases

Abstract: Spontaneous spinal hematomas are frequently located in the thoracic spine. Subdural spinal haemorrhage is more frequent than epidural. Epidural haemorrhage is frequently located dorsal to the spinal cord because of the tight fixation of the dura to the vertebral bodies.

Cited by 99 publications

References 17 publications

Spinal subdural hematoma: a rare case of spinal subdural hematoma complicating routine, minimally invasive lumbar discectomy and decompression and relevant literature review

Spinal subdural hematoma: a rare case of spinal subdural hematoma complicating routine, minimally invasive lumbar discectomy and decompression and relevant literature review

Diffusion-weighted MRI of spinal cord infarction

Development of Cervical Subarachnoid Hematoma Following Coronal Artery Stenting for Angina Pectoris -Case Report-

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