Traumatic Subacute Spinal Subdural Hematoma Concomitant with Symptomatic Cranial Subdural Hematoma: Possible Mechanism

Golden, Nyoman; Asih, Made Widhi

doi:10.1016/j.wneu.2018.12.053

Cited by 7 publications

(4 citation statements)

References 16 publications

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“…Due to the limited number of cases, the optimal management for concurrent intracranial and spinal SDH is not clear. However, among previously reported similar cases, intracranial SDH was preferentially treated surgically, while lumbar SDH was observed [6,26], as in the current case. While craniotomy and burr hole craniostomy have both been used for intracranial SDH, a recent systematic review reported that the less invasive burr hole approach, as used in the current case, is associated with a reduced recurrence and reoperation rate and shorter duration of operation compared to minicraniotomy [27].…”

Section: Discussionsupporting

confidence: 70%

“…MRI is the optimal imaging modality for those suspected of spinal SDH [ 11 , 25 ], while either computed tomography or MRI is appropriate for suspected intracranial SDH [ 22 ]. As illustrated in the current case, the presence of spinal SDH or any signs of elevated intracranial pressure such as disorientation, headache, nausea, or vomiting warrants brain neuroimaging to rule out intracranial SDH, regardless of a history of direct head injury [ 6 , 26 ]. The detection of SDH warrants an emergency surgical referral.…”

Section: Discussionmentioning

confidence: 99%

“…Concomitant intracranial and spinal SDH is usually the result of trauma [ 6 ]. While high-energy trauma is typically required to cause SDH in younger individuals, in older individuals, SDH may result from minor trauma [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Conversely, the spinal subdural space contains few blood vessels and is less often a source of bleeding [ 3 ]. However, as the intracranial and spinal subdural spaces are continuous with one another, intracranial SDH may redistribute to the lumbar subdural space as a result of gravity [ 5 , 6 ]. A recent review in 2020 identified 16 cases of spinal SDH that occurred in relation to intracranial SDH that had migrated inferiorly [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Concurrent Spinal and Intracranial Subdural Hematomas as a Cause of Near-Fatal Low Back Pain in the Chiropractic Office: A Case Report

Chu¹,

Trager²,

Nga³

et al. 2022

Cureus

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In older individuals, minor trauma may cause potentially fatal intracranial subdural hematoma (SDH). Rarely, these patients present with only low back and radicular pain as gravity redistributes the SDH to the lumbar spine.A 69-year-old male presented to a chiropractor with a 10-day history of acute on chronic low back pain, which radiated into his lower extremities bilaterally, involving weakness and difficulty walking, and a ground-level fall onto his elbows 16 days prior. He had visited his primary care provider, orthopedist, and traditional Chinese medicine practitioner, received oral analgesics and three ketorolac injections, and had lumbar radiographs, followed by acupuncture, cupping, and spinal manipulation without lasting relief. Considering the patient's concerning presentation, the chiropractor ordered lumbar magnetic resonance imaging (MRI) on the first visit, revealing findings suggestive of late subacute lumbar SDH, and recommended urgent brain MRI and neurosurgical referral. The patient went to an orthopedic surgeon at a nearby hospital, becoming disoriented upon presentation, prompting admission. Brain MRI confirmed bilateral chronic intracranial SDH, prompting emergency hematoma evacuation via burr hole craniostomy. The patient's gait rapidly improved, and the pain subsided over the following two weeks. This case highlights an older male identified as having spinal SDH by a chiropractor, leading to referral and surgery for concurrent life-threatening intracranial SDH. Clinicians should be aware that spinal SDH may stem from asymptomatic intracranial SDH and should be suspicious of SDH in older individuals after a fall, signs of which warrant emergency referral for MRI and surgical evaluation.

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Section: Discussionsupporting

confidence: 70%