Subdural Thoracolumbar Spine Hematoma after Spinal Anesthesia: A Rare Occurrence and Literature Review of Spinal Hematomas after Spinal Anesthesia

Maddali, Prasanthi; Walker, Blake; Fisahn, Christian; Page, Jeni; Diaz, Vicki; Zwillman, Michael; Oskouian, Rod J.; Tubbs, R. Shane; Moisi, Marc

doi:10.7759/cureus.1032

Cited by 8 publications

(6 citation statements)

References 31 publications

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“…Whatever be the source of bleed most cases of SSDHs following LP have been reported following entry into the spinal arachnoidal space during procedure. We could find only two cases 11,12 prior to ours where SSDH was the result of an epidural anesthesia, while in one more case 13 it was after a combined epidural-spinal anesthesia was given.…”

Section: Discussionmentioning

confidence: 73%

Spinal Subdural Hematoma following Epidural Anesthesia

et al. 2023

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The spinal subdural space is an avascular, potential space and is a rare location for intraspinal hematomas. Compared to spinal epidural hematomas, spinal subdural hematomas are uncommonly described complications of lumbar puncture for spinal or epidural anesthesia, particularly in patients who have no pre-existing bleeding disorders or history of antiplatelet or anticoagulant intake. We describe a 19-year-old girl who had a large thoracolumbar spinal subdural hematoma following epidural anesthesia for elective cholecystectomy with no pre-existing bleeding diathesis that caused rapidly developing paraplegia that evolved over the next 2 days following surgery. Nine days after the initial surgery she underwent multilevel laminectomy and surgical evacuation with eventual satisfactory recovery. Even epidural anesthesia without thecal sac violation can result in bleeding in the spinal subdural space. The possible sources of bleed in this space may be from injury to an interdural vein or extravasation of subarachnoid bleed into the subdural space. When neurological deficits occur, prompt imaging is mandatory and early evacuation yields gratifying results.

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Section: Discussionmentioning

confidence: 73%

Spinal Subdural Hematoma following Epidural Anesthesia

et al. 2023

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“…MRI can easily find a small hemorrhage and accurately reflect its size, shape, location, and relationship with the surrounding tissue. Moreover, tumors and inflammation can be distinguished by a signal difference in MRI [16]. In this case, MRI clearly indicated hematoma in the T12-S1 level spinal canal based on the abnormal signal.…”

Section: Discussionmentioning

confidence: 75%

Spinal Subdural Hematoma in a Young Adult with Hemophilia A: A Case Report

Yan¹,

Ye²,

Zeng³

et al. 2020

CMR

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Hemophilia is a set of hereditary hemorrhagic disorders of coagulation-dysfunction that can cause repeated bleeding in various tissues and organs. And the patient can be disabled due to bleeding from bones, joints, and soft tissue, or die due to splenic rupture or intracranial bleeding. So it is crucial to detect the site of bleeding in hemophilia patients quickly. Spontaneous spinal canal hematoma is a rare complication of hemophilia, with less than 50 cases reported to date. It can be easily missed and cause serious harm to patients. Hematoma, if untreated, causes irreversible nerve damage by compression of the spinal cord. Early recognition and treatment are most useful to prevent spontaneous spinal canal hematoma. We describe the case of a 21-year-old man with severe lumbago for two days, who had hemophilia A for a decade. The patient was diagnosed with spinal subdural hematoma by magnetic resonance imaging (MRI) after ruling out other causes of lumbago and treated with drugs by a neurologist. The hematoma showed absorption by MRI after six months. In conclusion, spontaneous spinal canal hematoma is a severe complication of hemophilia, which is often missed. This successful case confirms the importance of early diagnosis and treatment of spontaneous spinal canal hematoma. We hope to increase the clinicians' vigilance of this disease.

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“…Most commonly, spinal hematoma is seen in the epidural space; it is rarely seen in the subdural space or subarachnoid space. The subdural and subarachnoid hematomas can cause neural compression comparable to or worse than epidural hematoma [6]. The mechanism of hematoma formation in the spinal subdural space remains unclear [6].…”

Section: Discussionmentioning

confidence: 99%

Infected Spinal Hematoma After Accidental Exteriorization of an Epidural Catheter: A Case Report

Oliveira,

Fonseca,

Fernandes

et al. 2023

Cureus

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Optimal treatment and outcome after spinal hematoma remain unclear. Close neurological monitoring is the key to successful treatment. Here, we present a case of an infected spinal hematoma management.We report the case of a 51-year-old male patient, American Society of Anesthesiologists physical status I, admitted to a level I hospital due to right lower limb necrotizing fasciitis. A lumbar epidural catheter was placed for pain control without complications. On the 26th day of hospitalization, three hours after the accidental exteriorization of the epidural catheter, the patient developed severe back pain not relieved by systemic analgesia. Prophylactic low-molecular-weight heparin had been administered less than six hours before. The patient had inflammatory signs and digital pressure pain at the catheter insertion site and a positive Brudzinski sign. Sensory-motor deficits were never felt. An urgent dorsolumbar MRI exhibited a significant hematic collection at the subdural and anterior epidural level, and an infected epidural hematoma was assumed. Empirical antibiotics and hourly monitoring of sensory-motor deficits, meningeal signs, and fever were initiated. The patient remained on absolute bed rest. Low-molecular-weight heparin was stopped. The pain disappeared on the third day after the MRI. Citrobacter koseri was isolated. A reevaluation CT scan did not show spinal compression. The patient was discharged on the 27th day after an MRI in an asymptomatic condition and was referred to acute pain consultation.Neurological deficits are usually expected at the time of spinal hematoma diagnosis. However, the classic triad of pain, sensory deficits, and motor deficits is only seen in less than half of patients. Our patient only developed severe lumbar pain. In selected cases, diagnostic MRI associated with tight monitoring and conservative management can be applied.

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Subdural Thoracolumbar Spine Hematoma after Spinal Anesthesia: A Rare Occurrence and Literature Review of Spinal Hematomas after Spinal Anesthesia

Cited by 8 publications

References 31 publications

Spinal Subdural Hematoma following Epidural Anesthesia

Spinal Subdural Hematoma following Epidural Anesthesia

Spinal Subdural Hematoma in a Young Adult with Hemophilia A: A Case Report

Infected Spinal Hematoma After Accidental Exteriorization of an Epidural Catheter: A Case Report

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