Spontaneous idiopathic spinal subdural hemorrhage in a 16‐year‐old boy: A rare case in pediatrics and review of literature

Abstract

Spontaneous subdural hematoma (SSDH) is a rare condition resulting in cord compression and is associated with significant mortality and morbidity. Spinal SDH can be secondary to anticoagulation therapy, blood dyscrasia, spinal puncture, trauma, spinal anesthesia, or vascular malformation. However, spontaneous SDH is rare, and pathophysiology is still unknown. 1 Rupture of the vasculature within the subarachnoid or subdural space has been proposed as a potential pathogenic mechanism in certain cases. While some suggest that the bleeding originates from the subarachnoid vessels with concomitant rupture into the subdural space following an increase in intra-abdominal or intra-thoracic pressure, others have proposed an alternative theory that the bleeding begins in the subdural space itself. 2 The clinical manifestations of SSDH are related to cord compression and vary from back pain to motor, sensory, and autonomic dysfunction. 3,4 The main approach for confirming the diagnosis is magnetic resonance imaging (MRI). 5 Although surgical intervention through decompression is considered as the main treatment option, percutaneous drainage or conservative therapies are also

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

“… 16 Additionally, there is utility in frequent MRI during the acute presentation phase to monitor the development from hemorrhage to hematoma, to guide surgical decision-making when correlated with the observed clinical symptoms. 6 The management of a recurrent arachnoid cyst is complex and can involve nonoperative management to invasive redo decompression with cyst fenestration and adhesiolysis. The diagnostic process involves advanced imaging modalities such as MRI to provide valuable insights into the location, extent, and compressive effects of the hematoma on the spinal cord.…”

“…In patients with severe, acute-onset, or worsening SSAH-related symptoms, decompression or laminectomy is a common surgical intervention. 5 , 6 In this report, we present a surgical video for a patient with spontaneous SSAH of the thoracic spine that recurred following initial surgery and presented as arachnoiditis with spinal adhesions. A review of the pertinent literature is included.…”