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Spontaneous Spinal Subdural Hematoma: Case Report of 2 Years' Clinical and Radiologic Findings.
World Neurosurg. 2019 Jul; 127:275-278.WN

Abstract

BACKGROUND

Spontaneous spinal subdural hematoma (SDH) is rare but leads to severe nerve compression. According to the symptoms, surgery decompression and conservative treatment are justified options. We present a spontaneous spinal SDH case treated by decompression surgery for the lumbar region and conservative observation for the thoracic region. A series of images of the disease course is available.

CASE DESCRIPTION

A 55-year-old woman without malignancy or coagulopathy history presented with progressive low back pain for the past 2 weeks. Progressive bilateral leg weakness happened 1 week ago. On the day she called for help, she presented with bilateral leg grade 2 muscle power and generalized back pain. There was no headache or meningeal sign. An absent bilateral knee reflex was found. Magnetic resonance imaging showed a space-occupying lesion at the T2-T6 and T12-L1 levels in the ventral and dorsal spinal canal, leading to cord compression. Due to rapid neurologic function deterioration, emergent T12-L1 laminectomy was performed. We found a T12-L1 tense dura sac with subdural hematoma ventral to the cord. Removal of the SDH was performed. T2-T6 levels were treated conservatively. She returned ambulant 1 week after operation. Magnetic resonance images at 3 months and 1 year later showed the SDH being absorbed and replaced by adhesive arachnoid cysts along the whole T and L spine. However, these lesions are asymptomatic for at least 2 years.

CONCLUSIONS

Surgical intervention is recommended in patients presenting with severe neurologic deficits. Conservative treatment is a reasonable option for asymptomatic patients.

Authors+Show Affiliations

Department of Neurosurgery, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan.Department of Neurosurgery, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan. Electronic address: sychen0102@gmail.com.Department of Neurosurgery, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan.Department of Neurosurgery, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

30986583

Citation

Gan, Cheat-Wei, et al. "Spontaneous Spinal Subdural Hematoma: Case Report of 2 Years' Clinical and Radiologic Findings." World Neurosurgery, vol. 127, 2019, pp. 275-278.
Gan CW, Chen SY, Chang CS, et al. Spontaneous Spinal Subdural Hematoma: Case Report of 2 Years' Clinical and Radiologic Findings. World Neurosurg. 2019;127:275-278.
Gan, C. W., Chen, S. Y., Chang, C. S., & Liu, J. D. (2019). Spontaneous Spinal Subdural Hematoma: Case Report of 2 Years' Clinical and Radiologic Findings. World Neurosurgery, 127, 275-278. https://doi.org/10.1016/j.wneu.2019.04.063
Gan CW, et al. Spontaneous Spinal Subdural Hematoma: Case Report of 2 Years' Clinical and Radiologic Findings. World Neurosurg. 2019;127:275-278. PubMed PMID: 30986583.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Spontaneous Spinal Subdural Hematoma: Case Report of 2 Years' Clinical and Radiologic Findings. AU - Gan,Cheat-Wei, AU - Chen,Se-Yi, AU - Chang,Cheng-Shiu, AU - Liu,Jung-Dung, Y1 - 2019/04/13/ PY - 2019/03/11/received PY - 2019/04/07/revised PY - 2019/04/08/accepted PY - 2019/4/16/pubmed PY - 2020/1/14/medline PY - 2019/4/16/entrez KW - Conservative treatment KW - Decompression KW - Magnetic resonance imaging KW - Spinal subdural hematoma SP - 275 EP - 278 JF - World neurosurgery JO - World Neurosurg VL - 127 N2 - BACKGROUND: Spontaneous spinal subdural hematoma (SDH) is rare but leads to severe nerve compression. According to the symptoms, surgery decompression and conservative treatment are justified options. We present a spontaneous spinal SDH case treated by decompression surgery for the lumbar region and conservative observation for the thoracic region. A series of images of the disease course is available. CASE DESCRIPTION: A 55-year-old woman without malignancy or coagulopathy history presented with progressive low back pain for the past 2 weeks. Progressive bilateral leg weakness happened 1 week ago. On the day she called for help, she presented with bilateral leg grade 2 muscle power and generalized back pain. There was no headache or meningeal sign. An absent bilateral knee reflex was found. Magnetic resonance imaging showed a space-occupying lesion at the T2-T6 and T12-L1 levels in the ventral and dorsal spinal canal, leading to cord compression. Due to rapid neurologic function deterioration, emergent T12-L1 laminectomy was performed. We found a T12-L1 tense dura sac with subdural hematoma ventral to the cord. Removal of the SDH was performed. T2-T6 levels were treated conservatively. She returned ambulant 1 week after operation. Magnetic resonance images at 3 months and 1 year later showed the SDH being absorbed and replaced by adhesive arachnoid cysts along the whole T and L spine. However, these lesions are asymptomatic for at least 2 years. CONCLUSIONS: Surgical intervention is recommended in patients presenting with severe neurologic deficits. Conservative treatment is a reasonable option for asymptomatic patients. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/30986583/Spontaneous_Spinal_Subdural_Hematoma:_Case_Report_of_2_Years'_Clinical_and_Radiologic_Findings_ DB - PRIME DP - Unbound Medicine ER -