Treatment of Spontaneous Cervical Spinal Subdural Hematoma with Methylprednisolone Pulse Therapy

Song, Tae Jin; Lee, Jun Bum; Choi, Young Chul; Lee, Ki Young; Kim, Won Joo

doi:10.3349/ymj.2011.52.4.692

Cited by 18 publications

(11 citation statements)

References 14 publications

(13 reference statements)

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“…Bleeding disorders were mainly noted as those that impair the hemostatic mechanism including leukemia, hemophilia, thrombocytopenia, cryoglobulinemia, hemorrhagic diathesis, and polycythemia. Although less common, cases of spontaneous sSDH have been reported in the following conditions: ankylosing spondylitis [ 17 , 42 ], systemic lupus erythematosus [ 43 ], fibromuscular dysplasia [ 24 ], cystic fibrosis [ 44 ], polycystic kidney disease [ 25 ], chronic renal failure [ 34 ], rhabdomyolysis [ 31 ], rheumatoid arthritis [ 32 ], pregnancy [ 45 ], and eclampsia [ 46 ]. Although an underlying coagulopathy, anticoagulant therapy, or an iatrogenic cause can be implicated in most cases of spontaneous sSDH, a significant proportion of patients have no readily identifiable cause; thus further investigation of these cases is warranted.…”

Section: Discussionmentioning

confidence: 99%

Acute, Nontraumatic Spontaneous Spinal Subdural Hematoma: A Case Report and Systematic Review of the Literature

Rettenmaier

Holland

Abel

2017

Case Reports in Neurological Medicine

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Spontaneous spinal subdural hematoma (sSDH) is a rare condition outright. Moreover, cases that occur spontaneously in the absence of an identifiable etiology are considerably less common and remain poorly understood. Here, we present the case of a 43-year-old man with spontaneous sSDH presenting with acute onset low back pain and paraplegia. Urgent magnetic resonance imaging identified a dorsal SDH from T8 to T11 with compression of the spinal cord. Emergent T8–T10 laminectomies with intradural exploration and hematoma evacuation were performed. However, despite prompt identification and appropriate action, the patient's recovery was modest and significant disability remained at discharge. This unique and unusual case demonstrates that spontaneous sSDH requires prompt surgical treatment to minimize associated morbidity and supports the association between the presence of severe neurological deficits upon initial presentation with less favorable outcomes. We performed a comprehensive systematic review of spontaneous sSDH of unknown etiology, which demonstrates that emergent surgical intervention is indicated for patients presenting with severe neurological deficits and the presence of these deficits is predictive of poor neurological outcome. Furthermore, conservative management should be considered in patients presenting with mild neurological deficits as spontaneous resolution followed by favorable neurological outcomes is often observed in these patients.

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Section: Discussionmentioning

confidence: 99%

Acute, Nontraumatic Spontaneous Spinal Subdural Hematoma: A Case Report and Systematic Review of the Literature

Rettenmaier

Holland

Abel

2017

Case Reports in Neurological Medicine

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“…In Korea, three cases of spontaneous SSDH presenting with paraparesis have been previously reported-two cases affecting the ventral portion and one case with a dorsal hemorrhage 13) . All three underwent lumbar drainage and methylprednisolone pulse therapy 6 17) , with good clinical outcome. According to Boukobza et al 1) , conservative treatment is possible if early recovery is observed, deficits are mild, degree of hematoma extension precludes surgical treatment, or a coagulopathy is associated.…”

Section: Discussionmentioning

confidence: 96%

Spontaneous Spinal Subdural Hematoma causing Brown-Séquard Syndrome with Thrombocytopenic Myelodysplastic Syndrome

et al. 2015

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Spontaneous spinal subdural hematoma (SSDH) is a very rare condition. We report a case of SSDH presenting with Brown-Séquard syndrome, treated by surgical evacuation. A 77-year-old woman was hospitalized for back pain without trauma history. As she showed progressive sensory loss and right-side dominant paraparesis, we performed magnetic resonance imaging and confirmed the SSDH in the thoracic area. Therefore, she underwent emergent operation and the hematoma was evacuated successfully. After the operation, the patient showed improvement in neurologic function.

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“…Several cases of cervical or cervicothoracic SSDH have been reported. 1 , 13 – 17 Among them, only a few cases with obvious neurological symptoms and accurate diagnoses experienced the spontaneous resolution of the haematoma. 15 , 16 However, a few cases reported idiopathic SSDH without underlying pathological conditions located only in the cervical region.…”

Section: Discussionmentioning

confidence: 99%

“… 22 Moreover, in a few cases of cervical or cervicothoracic SSDH, the haematomas were spontaneously absorbed or recovered after the administration of conservative treatment such as methylprednisolone pulse therapy. 12 , 15 – 17 …”

Section: Discussionmentioning

confidence: 99%

Idiopathic cervical spinal subdural haematoma: a case report and literature review

2019

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This report describes a case of idiopathic cervical spinal subdural haematoma (SSDH) in which the haematoma was spontaneously absorbed without any treatment. A 68-year-old male patient presented with persistent neck pain and no obvious cause. Magnetic resonance imaging (MRI) revealed a space-occupying lesion at the C4–T1 levels. The lesion was initially misdiagnosed as a tumour. An operation was arranged to remove the tumour, but a preoperative computed tomography scan showed no obvious abnormal soft tissue density in the cervical spinal canal. Repeat enhanced MRI showed degeneration of the cervical vertebrae, but no obvious abnormal soft tissue density and no obvious enhanced signals in the cervical spinal canal. Spontaneous resolution of an idiopathic cervical SSDH was considered. Idiopathic cervical SSDH without obvious neurological symptoms are difficult to diagnose, so suspected cases should be carefully monitored. If the neurological symptoms grow progressively more debilitating with time, emergency surgery might need to be considered. To avoid unnecessary surgery, conservative management should be an option for patients with minimal neurological deficits and re-examination with MRI could be the best way to observe the dynamic changes taking place in the idiopathic cervical SSDH.

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Treatment of Spontaneous Cervical Spinal Subdural Hematoma with Methylprednisolone Pulse Therapy

Cited by 18 publications

References 14 publications

Acute, Nontraumatic Spontaneous Spinal Subdural Hematoma: A Case Report and Systematic Review of the Literature

Acute, Nontraumatic Spontaneous Spinal Subdural Hematoma: A Case Report and Systematic Review of the Literature

Spontaneous Spinal Subdural Hematoma causing Brown-Séquard Syndrome with Thrombocytopenic Myelodysplastic Syndrome

Idiopathic cervical spinal subdural haematoma: a case report and literature review

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