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Prospective assessment of concomitant lumbar and chronic subdural hematoma: is migration from the intracranial space involved in their manifestation?
J Neurosurg Spine. 2014 Feb; 20(2):157-63.JN

Abstract

OBJECT

Spinal subdural hematomas (SDHs) are rare and some are concomitant with intracranial SDH. Their pathogenesis and etiology remain to be elucidated although their migration from the intracranial space has been suggested. The authors postulated that if migration plays a major role, patients with intracranial SDH may harbor asymptomatic lumbar SDH. The authors performed a prospective study on the incidence of spinal SDH in patients with intracranial SDH to determine whether migration is a key factor in their concomitance.

METHODS

The authors evaluated lumbar MR images obtained in 168 patients (125 males, 43 females, mean age 75.6 years) with intracranial chronic SDH to identify cases of concomitant lumbar SDH. In all cases, the lumbar MRI studies were performed within the 1st week after surgical irrigation of the intracranial SDH.

RESULTS

Of the 168 patients, 2 (1.2%) harbored a concomitant lumbar SDH; both had a history of trauma to both the head and the hip and/or lumbar area. One was an 83-year-old man with prostate cancer and myelodysplastic syndrome who suffered trauma to his head and lumbar area in a fall from his bed. The other was a 70-year-old man who had hit his head and lumbar area in a fall. Neither patient manifested neurological deficits and their hematomas disappeared under observation. None of the patients with concomitant lumbar SDH had sustained head trauma only, indicating that trauma to the hip or lumbar region is significantly related to the concomitance of SDH (p < 0.05).

CONCLUSIONS

As the incidence of concomitant lumbar and intracranial chronic SDH is rare and both patients in this study had sustained a direct impact to the head and hips, the authors suggest that the major mechanism underlying their concomitant SDH was double trauma. Another possible explanation is hemorrhagic diathesis and low CSF syndrome.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Kokubo R
Department of Neurosurgery, Nippon Medical School Chiba Hokuso Hospital, Chiba;
Kim K
No affiliation info available
Mishina M
No affiliation info available
Isu T
No affiliation info available
Kobayashi S
No affiliation info available
Yoshida D
No affiliation info available
Morita A
No affiliation info available

MeSH

AdultAgedAged, 80 and overFemaleHematoma, Subdural, ChronicHematoma, Subdural, IntracranialHematoma, Subdural, SpinalHumansMagnetic Resonance ImagingMaleMiddle AgedProspective Studies

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24286531

Citation

Kokubo, Rinko, et al. "Prospective Assessment of Concomitant Lumbar and Chronic Subdural Hematoma: Is Migration From the Intracranial Space Involved in Their Manifestation?" Journal of Neurosurgery. Spine, vol. 20, no. 2, 2014, pp. 157-63.
Kokubo R, Kim K, Mishina M, et al. Prospective assessment of concomitant lumbar and chronic subdural hematoma: is migration from the intracranial space involved in their manifestation? J Neurosurg Spine. 2014;20(2):157-63.
Kokubo, R., Kim, K., Mishina, M., Isu, T., Kobayashi, S., Yoshida, D., & Morita, A. (2014). Prospective assessment of concomitant lumbar and chronic subdural hematoma: is migration from the intracranial space involved in their manifestation? Journal of Neurosurgery. Spine, 20(2), 157-63. https://doi.org/10.3171/2013.10.SPINE13346
Kokubo R, et al. Prospective Assessment of Concomitant Lumbar and Chronic Subdural Hematoma: Is Migration From the Intracranial Space Involved in Their Manifestation. J Neurosurg Spine. 2014;20(2):157-63. PubMed PMID: 24286531.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prospective assessment of concomitant lumbar and chronic subdural hematoma: is migration from the intracranial space involved in their manifestation? AU - Kokubo,Rinko, AU - Kim,Kyongsong, AU - Mishina,Masahiro, AU - Isu,Toyohiko, AU - Kobayashi,Shiro, AU - Yoshida,Daizo, AU - Morita,Akio, Y1 - 2013/11/29/ PY - 2013/11/30/entrez PY - 2013/11/30/pubmed PY - 2014/4/9/medline SP - 157 EP - 63 JF - Journal of neurosurgery. Spine JO - J Neurosurg Spine VL - 20 IS - 2 N2 - OBJECT: Spinal subdural hematomas (SDHs) are rare and some are concomitant with intracranial SDH. Their pathogenesis and etiology remain to be elucidated although their migration from the intracranial space has been suggested. The authors postulated that if migration plays a major role, patients with intracranial SDH may harbor asymptomatic lumbar SDH. The authors performed a prospective study on the incidence of spinal SDH in patients with intracranial SDH to determine whether migration is a key factor in their concomitance. METHODS: The authors evaluated lumbar MR images obtained in 168 patients (125 males, 43 females, mean age 75.6 years) with intracranial chronic SDH to identify cases of concomitant lumbar SDH. In all cases, the lumbar MRI studies were performed within the 1st week after surgical irrigation of the intracranial SDH. RESULTS: Of the 168 patients, 2 (1.2%) harbored a concomitant lumbar SDH; both had a history of trauma to both the head and the hip and/or lumbar area. One was an 83-year-old man with prostate cancer and myelodysplastic syndrome who suffered trauma to his head and lumbar area in a fall from his bed. The other was a 70-year-old man who had hit his head and lumbar area in a fall. Neither patient manifested neurological deficits and their hematomas disappeared under observation. None of the patients with concomitant lumbar SDH had sustained head trauma only, indicating that trauma to the hip or lumbar region is significantly related to the concomitance of SDH (p < 0.05). CONCLUSIONS: As the incidence of concomitant lumbar and intracranial chronic SDH is rare and both patients in this study had sustained a direct impact to the head and hips, the authors suggest that the major mechanism underlying their concomitant SDH was double trauma. Another possible explanation is hemorrhagic diathesis and low CSF syndrome. SN - 1547-5646 UR - https://www.unboundmedicine.com/medline/citation/24286531/Prospective_assessment_of_concomitant_lumbar_and_chronic_subdural_hematoma:_is_migration_from_the_intracranial_space_involved_in_their_manifestation DB - PRIME DP - Unbound Medicine ER -