Spinal subdural haematoma concurrent with cranial subdural haematoma: Report of two cases and review of literature

Abstract

Subdural haematomas co-existing in the cranium and spine are considered extremely rare. We report 2 cases demonstrating the condition described here with a review of literature. One of these 2 patients was the first case in which the spinal lesion was found before the cranial lesion. A 66-year-old man without trauma presented with paraparesis accompanied by severe leg pain. The patient was diagnosed as having spinal subdural haematoma extending from L1 to S1 vertebral levels with magnetic resonance images (MRI). Two days after admission, the patient developed disorientation and abnormal behavior; therefore, computed tomography (CT) of brain was performed, and chronic cranial subdural haematoma was observed. A 60-year-old man who developed headache showing gradually progressive was diagnosed as having cranial subdural haematoma on CT. Three days after admission, he became insomnolent due to severe low back pain radiating to ankle. On MRI, subdural haematoma was found extending from L3/4 to S2 vertebral levels. Only brain surgery was performed for all cases by the neurosurgeons. Paraparesis and severe leg pain, which were derived from spinal lesions, showed recovery approximately 2 weeks after onset and spinal subdural haematoma was completely resolved on MRI obtained 2 or 5 months after onset, respectively. There is a possibility that the incidence of spinal subdural haematoma concurrent with cranial subdural haematoma could be underestimated because the doctor had not obtained CT or MRI of the brain. Doctors should aware of such a condition and check patients with spinal subdural haematoma for neurological signs derived from brain lesions. Spontaneous resolution of spinal subdural haematoma was observed; therefore, surgery for this condition should be indicated only for patients with moderate or severe paraparesis or paraparesis deteriorated.

An unusual cause of back pain in a child: spinal subdural haematoma secondary to intracranial arachnoid cyst haemorrhage

“…Fewer than 30 cases of spontaneous intracystic haemorrhage have been reported in the literature, at least six of which occurred in patients under the age of 18 (7)(8)(9)(10)(11). Patients with these complications would be expected to present with headache, vomiting or neck stiffness (11,12). However, our patient did not describe any of these symptoms.…”

“…In a similar case described by Lohani et al, the patient was also managed nonoperatively, although oral steroids were given due to clinical evidence of radiculopathy (11). Spontaneous resolution of the intracranial and spinal haematomas was reported in that case and has also been described elsewhere in the literature (11)(12)(13). If there is mass effect or neurological deficit, several surgical options are available.…”

Spinal Subdural Hematoma Associated With Traumatic Intracranial Interhemispheric Subdural Hematoma

“…However, spontaneous resolution of SSDH has also been reported. 5,12,18) In our case, complete resolution of the possibly asymptomatic SSDH was confirmed on MR imaging 2 months after onset. Severe osteoarthritis of the knee could present with drop foot caused by disturbance of the anterior tibial and peroneal compartments.…”

“…18) In addition, migration from the cerebral subdural area to the spinal subdural space is a very likely cause of SSDH. 3,5,11) However, cases of SSDHs concurrent with traumatic intracranial SDHs are extremely rare, with only 11 reported cases 3,5,6,8,9,11,12,15,16,18) including our case (Table 1). In our case, slight posterior fossa SDH was observed on the initial head CT, but the hematoma disappeared with time.…”

“…3,5,6,8,9,12,16,18) Some factors triggering or contributing to the development of SSDH have been reported. 18) In addition, migration from the cerebral subdural area to the spinal subdural space is a very likely cause of SSDH.…”