Uncommon Magnetic Resonance Imaging Observation of Lumbar Subdural Hematoma with Cranial Origin

Abstract

A patient with a history of pain, paresthesias, and weakness in both legs is reported. Magnetic resonance imaging (MRI) of the lumbar spine demonstrated subacute subdural hematoma. Brain MRI obtained 1 day later because of progressive headache showed hemorrhagic cortical metastasis and extensive subdural hematoma. It is hypothesized that the lumbar hematoma originated from the intracranial bleeding, which was substantiated by the observation of a thin hemorrhagic collection connecting cranial and lumbar hematomas on MRI. Cranial origin should be included in the differential diagnosis of spontaneous spinal subdural hematomas.

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

“…Of these cases, 3 involved patients who had undergone ventricu loperitoneal (VP) shunt placement, 31,37,42 3 cases were postcraniotomy, 26,36,43 17 were posttrauma, 1,4,5,7,8,13,17,20,21,24,29,30,34,35,[39][40][41] and in 12 cases the SDH arose spontaneous ly. [9][10][11]16,18,22,25,28,30,38,44,45 Leakage of intracranial SDH fluid into the spinal subdural space may be involved in patients who manifest spinal SDH after VP shunt placement. Low CSF pressure is a risk factor for spinal SDH 13,15,26,43 in the absence of intracranial SDH extension, and low CSF pressure syndrome elicited by the overflow of CSF in the VP shunt may result in concomitant hemorrhages.…”

“…Of 29 earlier patients with posttraumatic or spon taneous hematomas, 1,3,5,[7][8][9][10][11]13,[16][17][18][20][21][22]24,25,[28][29][30][31][34][35][36][37][38][39][40][41][42][43][44][45] 11 had undergone surgery, 2 aspiration by lumbar puncture, and 16 had been placed under observation. In both of our pa tients with concomitant asymptomatic spinal SDH the lesions resolved spontaneously with conservative man agement.…”

Simultaneous Cranial and Spinal Subdural Hematoma-Case Report-

“…1,5,[9][10][11][14][15][16]18,19) Five patients had acute SDH and six had chronic SDH. Four of 11 patients had undergone CSF diversion, such as ventriculoperitoneal or ventriculoatrial shunting, or external drainage several days or weeks before the onset.…”

“…9) Spinal hematoma may migrate from the cranial lesion. 1,10,11,18,19) Either high or low intracranial pressure has been proposed as a predisposing factor for this migration. Raised intracranial pressure due to brain swelling might displace the hematoma to the skull base or spinal canal.…”

“…3) More than 100 cases of spinal SDH have been reported, and magnetic resonance (MR) imaging has increased the incidence of detection. 3,10) Simultaneous spinal and cranial SDH is extremely rare, and may be a distinct subgroup, but only 10 cases have been reported. 1,5,[9][10][11][14][15][16]18,19) Here, we describe another case of spinal SDH with simultaneous cranial chronic SDH.…”