Spontaneous Resolution of Nontraumatic Acute Spinal Subdural Hematoma

Abstract

268hospital and was classified as grade 1. An examination found hypoesthesia at the T8 level and below and the deep tendon reflexes were reduced. We performed a chest computed tomography (CT) scan, but aortic dissection was not observed. We suspected hypokalemic periodic paralysis of both lower extremities and conducted laboratory studies; however, the results were negative. We then suspected thoracic myelopathy and thus provided steroid mega-dose therapy and conducted magnetic resonance imaging (MRI). The motor paralysis was gradually relieved so that the motor function were grade 2 on the right side and grade 3 on the left side four hours after the onset of symptoms. It was grade 4 on both sides after five hours. The MRI showed acute subdural hematoma at levels C2-T6 (Fig. 1A, C). Paralysis almost completely disappeared by 55 hours after onset. A cervical MRI conducted at that time revealed reduced cervicaldorsal SSDH (Fig. 1B, D). Case 2A 38-year-old male patient experienced headache, back pain, cold sweating, and dizziness that began when he was lifting weights one month earlier. These symptoms were relieved after he was treated at a clinic of pain medicine near his home. Three days later, he came to the emergency room with vertigo, which was relieved with intravenous hydration. Approximately one month later, his chest and back pain was aggravated by stretching exercises and he came to the emergency room. A brain MRI with contrast enhancement was conducted, which revealed thickening of the dura mater. The patient was then admitted to the neurologic department of the hospital with suspected spontaneous intracranial hypotension. The chest and back pain worsened and INTRODUCTIONSpinal subdural hematoma (SSDH) is a rare condition in which the spinal subdural hematoma compresses the spinal cord and the cauda equina, causing symptoms that may occur in relation to trauma, hemostatic disorders, anticoagulant drug administration, arteriovenous malformations, tumors, and lumbar punctures. Various unknown causes of SSDH have also been reported 4,11) . Its clinical symptoms are sudden pain, hypesthesia, motor paralysis, and neurologic defects in some cases [4][5][6]8,11,13) . Treatment generally consists of surgical decompression 3,15) . We experienced two cases of nontraumatic acute spinal subdural hematoma (NASSDH), treated conservatively without surgery. CASE REPORT Case 1A 55-year-old female patient came to the emergency room due to serious back pain that occurred during sleep. The patient had a past history of taking antihypertensive drugs and drugs to treat diabetes mellitus. Blood tests conducted in the emergency room did not reveal anything in particular. Paralysis of both lower extremities occurred after the patient came to the Department of Neurosurgery, Ewha Womans University School of Medicine, Mokdong Hospital, Seoul, KoreaSpinal subdural hematoma (SSDH) is an extremely uncommon condition. Causative factors include trauma, anticoagulant drug administration, hemostatic disorders, and vascular disor...

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

“…Therefore, low CSF pressure due to excessive surgical CSF drain age may have played an important role in the develop ment of spinal SDH. 15,26,43,46 Spinal SDH after craniotomy without intracranial SDH has also been reported. 15,23,26 Rader 32 suggested that a sudden increase in abdominal and thoracic pressure may rapidly elevate the pressure in the spinal vessels crossing the subdural and subarachnoid spaces and if CSF pressure fails to immediately buffer this force, vessel rupture may ensue.…”

Unusual localization of bleeding under acenocoumarol: Spinal subdural hematoma

“…SSH is most often located in the thoracic region [16]. The etiopathogenic mechanisms involved in the constitution of SSH remains unclear [[17], [18], [19]]. In the subdural spinal space, there are no major blood vessels in contrast with the spinal epidural space or the intracranial subdural space [18].…”

Rivaroxaban-Induced Nontraumatic Spinal Subdural Hematoma: An Uncommon Yet Life-Threatening Complication

“…Nontraumatic or spontaneous spinal hematomas are rare and are usually epidural in origin [ 10 ]. Spontaneous SSDH are extremely rare and are associated with numerous risk factors, such as iatrogenic causes (lumbar puncture, spinal anesthesia, and spinal surgery), bleeding disorders, spinal tumors, arteriovenous malformations, and OACs [ 10 – 13 ].…”