Spinal Subdural Hematoma Migration From a Cranial Subdural Hematoma: Two Case Reports and Literature Review

Abstract

Spinal subdural hematoma (SSDH) associated with cranial subdural hematoma (CSDH) is considered extremely rare and the etiology remains unclear. Herein, we report two cases of spontaneous SSDH concomitant with CSDH, with no history of trauma. First, a healthy 35-year-old woman suffered from left leg pain following a headache caused by acute CSDH. Magnetic resonance imaging (MRI) of the lumbar spine showed SSDH extending from the L5 to S2 vertebral levels. The leg symptoms were gradually relieved with conservative treatments within two weeks after onset. The SSDH was completely resolved six months after onset on MRI evaluations. Next, a 69-year-old woman developed a headache and right hemiparesis. Brain computed tomography (CT) demonstrated chronic left-sided CSDH and she underwent a single burr-hole craniotomy. Three weeks after surgery, she experienced difficulty walking because of severe leg pain caused by SSDH extending from the L3 to S1. The clinical symptoms were completely resolved with conservative treatment within one month after onset. At 3 months follow-up, SSDH disappeared on MRI evaluation. Herein, we presented two cases of SSDH associated with CSDH. In both cases, the leg symptoms of SSDH developed following the onset of CSDH. Given that both patients remained active during the interval between CSDH onset and the appearance of SSDH symptoms, the SSDH was likely caused by migration of the CSDH contents to the lumbar spine because of gravity.

Cerebral Vasospasm After Burr Hole Evacuation of Chronic Subdural Hematoma

“…This mechanical arterial stretching and release of spasmogenic substances from the injured parenchyma into the subarachnoid space may have caused cerebral vasospasm in our patient. To the best of our knowledge, only one similar CSDH case has been reported [9]. Furthermore, the mechanism of cerebral vasospasm in that case could be explained as posttraumatic cerebral vasospasm [5,6] because it was complicated by acute subdural hematoma.…”

Management of a recurrent spinal arachnoid cyst presenting as arachnoiditis in the setting of spontaneous spinal subarachnoid hemorrhage: illustrative case

“…1 Interestingly, there are few case reports in which patients initially present with stress-induced cardiomyopathy, 8,9 and few have concurrent or prior intracranial SAH. [10][11][12] In this case report, we describe a cryptogenic and challenging instance of spontaneous SSAH from T6 to T11 with an initial presentation of worsening myelopathy, back pain, and lower-extremity paresthesias. We highlight the complexity and evolving nature of spontaneous SSAH, underscoring the importance of prolonged neurosurgical follow-up and prompt repeat MRI when symptoms recur.…”