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Acute spontaneous spinal subdural hematoma in a patient with bilateral incarcerated inguinal hernia.
Joint Bone Spine. 2008 May; 75(3):345-7.JB

Abstract

OBJECTIVE

Acute spinal subdural hematoma is an infrequent and devastating condition that occurs mostly in patients with coagulopathy or receiving anticoagulants. It may also develop after trauma, spinal surgery or iatrogenically (lumbar puncture and/or spinal anaesthesia). Spinal vascular malformations or spinal tumours can also be the origins of subdural hematomas. However, acute spinal subdural hematomas, which are not associated with these risk factors, are seen even more infrequently. In this report, we have described a case of spontaneous acute spinal subdural hematoma that occurred in a patient with bilateral incarcerated inguinal hernia and discussed the possible pathomechanisms.

METHODS

A 50-year-old male was admitted to the emergency department for the acute onset of interscapular pain, slight weakness in both legs and urinary retention. Neurological examination revealed paraparesis (3/5 in left, 4/5 in right) and hypoesthesia below T5 dermatome. He had long-standing bilateral inguinal hernia and constipation for the last 5 days. Magnetic resonance imaging of the spine displayed an extramedullary acute hematoma at the T4-8 levels but it was impossible to identify whether the hematoma was extradural or intradural exactly. The patient underwent an urgent operation via T4-6 laminectomy. After opening the dura, an extensive, partially organized hematoma was completely removed by aspiration. Muscle strength was improved immediately; urinary retension was recovered on postoperative day 7. Constipation was relieved on postoperative day 4.

CONCLUSION

Acute spinal subdural hematoma is an emergency condition in case of neurological compromise. Urgent surgical evacuation of hematoma results in good outcome. In the case of unidentified etiologies, the conditions that could play a role in increased intraabdominal and/or intrathoracic pressure should be considered always.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Ozdemir O
Department of Neurosurgery, Baskent University Faculty of Medicine, Ankara, Turkey. ozgurhozdemir@yahoo.com
Calisaneller T
No affiliation info available
Yildirim E
No affiliation info available
Caner H
No affiliation info available
Altinors N
No affiliation info available

MeSH

Hematoma, Subdural, SpinalHernia, InguinalHumansLaminectomyMaleMiddle Aged

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

18337142

Citation

Ozdemir, Ozgur, et al. "Acute Spontaneous Spinal Subdural Hematoma in a Patient With Bilateral Incarcerated Inguinal Hernia." Joint Bone Spine, vol. 75, no. 3, 2008, pp. 345-7.
Ozdemir O, Calisaneller T, Yildirim E, et al. Acute spontaneous spinal subdural hematoma in a patient with bilateral incarcerated inguinal hernia. Joint Bone Spine. 2008;75(3):345-7.
Ozdemir, O., Calisaneller, T., Yildirim, E., Caner, H., & Altinors, N. (2008). Acute spontaneous spinal subdural hematoma in a patient with bilateral incarcerated inguinal hernia. Joint Bone Spine, 75(3), 345-7. https://doi.org/10.1016/j.jbspin.2007.05.019
Ozdemir O, et al. Acute Spontaneous Spinal Subdural Hematoma in a Patient With Bilateral Incarcerated Inguinal Hernia. Joint Bone Spine. 2008;75(3):345-7. PubMed PMID: 18337142.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute spontaneous spinal subdural hematoma in a patient with bilateral incarcerated inguinal hernia. AU - Ozdemir,Ozgur, AU - Calisaneller,Tarkan, AU - Yildirim,Erkan, AU - Caner,Hakan, AU - Altinors,Nur, Y1 - 2008/01/18/ PY - 2007/02/02/received PY - 2007/05/30/accepted PY - 2008/3/14/pubmed PY - 2008/6/19/medline PY - 2008/3/14/entrez SP - 345 EP - 7 JF - Joint bone spine JO - Joint Bone Spine VL - 75 IS - 3 N2 - OBJECTIVE: Acute spinal subdural hematoma is an infrequent and devastating condition that occurs mostly in patients with coagulopathy or receiving anticoagulants. It may also develop after trauma, spinal surgery or iatrogenically (lumbar puncture and/or spinal anaesthesia). Spinal vascular malformations or spinal tumours can also be the origins of subdural hematomas. However, acute spinal subdural hematomas, which are not associated with these risk factors, are seen even more infrequently. In this report, we have described a case of spontaneous acute spinal subdural hematoma that occurred in a patient with bilateral incarcerated inguinal hernia and discussed the possible pathomechanisms. METHODS: A 50-year-old male was admitted to the emergency department for the acute onset of interscapular pain, slight weakness in both legs and urinary retention. Neurological examination revealed paraparesis (3/5 in left, 4/5 in right) and hypoesthesia below T5 dermatome. He had long-standing bilateral inguinal hernia and constipation for the last 5 days. Magnetic resonance imaging of the spine displayed an extramedullary acute hematoma at the T4-8 levels but it was impossible to identify whether the hematoma was extradural or intradural exactly. The patient underwent an urgent operation via T4-6 laminectomy. After opening the dura, an extensive, partially organized hematoma was completely removed by aspiration. Muscle strength was improved immediately; urinary retension was recovered on postoperative day 7. Constipation was relieved on postoperative day 4. CONCLUSION: Acute spinal subdural hematoma is an emergency condition in case of neurological compromise. Urgent surgical evacuation of hematoma results in good outcome. In the case of unidentified etiologies, the conditions that could play a role in increased intraabdominal and/or intrathoracic pressure should be considered always. SN - 1778-7254 UR - https://www.unboundmedicine.com/medline/citation/18337142/Acute_spontaneous_spinal_subdural_hematoma_in_a_patient_with_bilateral_incarcerated_inguinal_hernia_ DB - PRIME DP - Unbound Medicine ER -