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Acute spontaneous spinal subdural hematoma presenting as paraplegia: a rare case.
Spine (Phila Pa 1976). 2007 Oct 01; 32(21):E619-22.S

Abstract

STUDY DESIGN

Case report.

OBJECTIVES

To report an unusual case of spontaneous spinal subdural hematoma and to review relevant literature and discuss the etiology, pathogenesis, clinical features, imaging, and prognosis.

SUMMARY OF BACKGROUND DATA

Spontaneous spinal subdural hematoma with no underline pathology is a very rare condition. Only 19 cases have been previously reported.

METHODS

The case of a 44-year-old man is presented. Pubmed (Medline) was used to search publications.

RESULTS

Our patient presented with sudden severe low back pain following a minimal effort, with rapid onset of complete paraplegia. MRI revealed an anterior subdural hematoma from T2-T6 with cord compression. An urgent laminectomy was performed. MRI scan, surgery, and CT angiogram did not reveal any underlying pathology to account for the subdural hematoma. The patient demonstrated substantial clinical improvement after 6 weeks of bed rest and intense rehabilitation program.

CONCLUSION

Spinal subdural hematoma (SSDH) is uncommon and can be caused by abnormalities of coagulation, blood dyscrasias, or trauma, underlying neoplasm, and arteriovenous malformation. SSDH is very rare in the absence of these underlying conditions. It occurs most commonly in the thoracic spine and presents with sudden back pain radiating to the arms, legs or trunk, varying degrees of motor, sensory, and autonomic disturbances. On MRI, SSDH is seen as a space-occupying lesion, usually ventrally, contained within the dura matter, and can demonstrate variable T1 and T2 signal depending on the age of the hematoma. The prognosis is variable. The majority of cases in the literature had surgical decompression, although cases that were managed conservatively have been reported to be successful as well. The indications of surgery need to be clarified.

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Authors+Show Affiliations

Kyriakides AE
Midlands Centre for Spinal Injuries, Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, UK. athkyriaky@yahoo.com
Lalam RK
No affiliation info available
El Masry WS
No affiliation info available

MeSH

Acute DiseaseAdultDiagnosis, DifferentialHematoma, Subdural, SpinalHumansMaleParaplegiaRadiography

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

17906565

Citation

Kyriakides, Athanasios E., et al. "Acute Spontaneous Spinal Subdural Hematoma Presenting as Paraplegia: a Rare Case." Spine, vol. 32, no. 21, 2007, pp. E619-22.
Kyriakides AE, Lalam RK, El Masry WS. Acute spontaneous spinal subdural hematoma presenting as paraplegia: a rare case. Spine (Phila Pa 1976). 2007;32(21):E619-22.
Kyriakides, A. E., Lalam, R. K., & El Masry, W. S. (2007). Acute spontaneous spinal subdural hematoma presenting as paraplegia: a rare case. Spine, 32(21), E619-22.
Kyriakides AE, Lalam RK, El Masry WS. Acute Spontaneous Spinal Subdural Hematoma Presenting as Paraplegia: a Rare Case. Spine (Phila Pa 1976). 2007 Oct 1;32(21):E619-22. PubMed PMID: 17906565.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute spontaneous spinal subdural hematoma presenting as paraplegia: a rare case. AU - Kyriakides,Athanasios E, AU - Lalam,Radesh K, AU - El Masry,Wagih S, PY - 2007/10/2/pubmed PY - 2007/12/6/medline PY - 2007/10/2/entrez SP - E619 EP - 22 JF - Spine JO - Spine (Phila Pa 1976) VL - 32 IS - 21 N2 - STUDY DESIGN: Case report. OBJECTIVES: To report an unusual case of spontaneous spinal subdural hematoma and to review relevant literature and discuss the etiology, pathogenesis, clinical features, imaging, and prognosis. SUMMARY OF BACKGROUND DATA: Spontaneous spinal subdural hematoma with no underline pathology is a very rare condition. Only 19 cases have been previously reported. METHODS: The case of a 44-year-old man is presented. Pubmed (Medline) was used to search publications. RESULTS: Our patient presented with sudden severe low back pain following a minimal effort, with rapid onset of complete paraplegia. MRI revealed an anterior subdural hematoma from T2-T6 with cord compression. An urgent laminectomy was performed. MRI scan, surgery, and CT angiogram did not reveal any underlying pathology to account for the subdural hematoma. The patient demonstrated substantial clinical improvement after 6 weeks of bed rest and intense rehabilitation program. CONCLUSION: Spinal subdural hematoma (SSDH) is uncommon and can be caused by abnormalities of coagulation, blood dyscrasias, or trauma, underlying neoplasm, and arteriovenous malformation. SSDH is very rare in the absence of these underlying conditions. It occurs most commonly in the thoracic spine and presents with sudden back pain radiating to the arms, legs or trunk, varying degrees of motor, sensory, and autonomic disturbances. On MRI, SSDH is seen as a space-occupying lesion, usually ventrally, contained within the dura matter, and can demonstrate variable T1 and T2 signal depending on the age of the hematoma. The prognosis is variable. The majority of cases in the literature had surgical decompression, although cases that were managed conservatively have been reported to be successful as well. The indications of surgery need to be clarified. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/17906565/Acute_spontaneous_spinal_subdural_hematoma_presenting_as_paraplegia:_a_rare_case_ L2 - https://doi.org/10.1097/BRS.0b013e318154c618 DB - PRIME DP - Unbound Medicine ER -