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Lumbar Subdural Hematoma Detected After Surgical Treatment of Chronic Intracranial Subdural Hematoma.
World Neurosurg. 2020 Feb; 134:472-476.WN

Abstract

BACKGROUND

Spinal subdural hematoma (SSDH), which can cause lower back pain, leg pain, and leg weakness, is rare and will usually be associated with a bleeding tendency, trauma, spinal vascular malformation, intraspinal tumor, or iatrogenic invasion. Only a few cases of SSDH after intracranial chronic subdural hematoma (CSDH) have been reported. We report a case of lumbar SSDH in the absence of predisposing factors after reoperation for recurrent intracranial CSDH, which improved with conservative treatment.

CASE DESCRIPTION

Approximately 1 month after falling, a 63-year-old woman was experiencing left hemiparesis and impaired orientation that was diagnosed as right intracranial CSDH using computed tomography. Surgical treatment of the CSDH led to immediate improvement of her symptoms. On postoperative day 29, the right CSDH had recurred with left hemiparesis, and successful reoperation relieved the symptoms within a few hours postoperatively. However, 1 day after the second operation, very small acute subdural hematomas in regions along the left tentorium cerebelli and left falx cerebri were found on computed tomography. On day 31, she complained of sitting-induced bilateral radiating lower limb pain. Magnetic resonance imaging on day 34 showed an acute SSDH at the L4-L5 level and a sacral perineural cyst filled with hematoma, although her radiating pain was showing improvement. She was treated conservatively and was discharged without symptoms on day 44.

CONCLUSIONS

Although SSDH is rare, it is important for neurosurgeons and physicians to consider the possibility of a SSDH when lower limb pain or paresis occurs after procedures that will result in rapid intracranial pressure alterations such as drainage of an intracranial CSDH.

Authors+Show Affiliations

Department of Neurosurgery, Kyoto Yamashiro General Medical Center, Kyoto, Japan. Electronic address: friendautumn@gmail.com.Department of Neurosurgery, Kyoto Yamashiro General Medical Center, Kyoto, Japan.Department of Neurosurgery, Kyoto Yamashiro General Medical Center, Kyoto, Japan.Department of Neurosurgery, Kyoto Yamashiro General Medical Center, Kyoto, Japan.Department of Neurosurgery, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

31756510

Citation

Fujita, Tomoaki, et al. "Lumbar Subdural Hematoma Detected After Surgical Treatment of Chronic Intracranial Subdural Hematoma." World Neurosurgery, vol. 134, 2020, pp. 472-476.
Fujita T, Iwamoto Y, Takeuchi H, et al. Lumbar Subdural Hematoma Detected After Surgical Treatment of Chronic Intracranial Subdural Hematoma. World Neurosurg. 2020;134:472-476.
Fujita, T., Iwamoto, Y., Takeuchi, H., Tsujino, H., & Hashimoto, N. (2020). Lumbar Subdural Hematoma Detected After Surgical Treatment of Chronic Intracranial Subdural Hematoma. World Neurosurgery, 134, 472-476. https://doi.org/10.1016/j.wneu.2019.11.053
Fujita T, et al. Lumbar Subdural Hematoma Detected After Surgical Treatment of Chronic Intracranial Subdural Hematoma. World Neurosurg. 2020;134:472-476. PubMed PMID: 31756510.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Lumbar Subdural Hematoma Detected After Surgical Treatment of Chronic Intracranial Subdural Hematoma. AU - Fujita,Tomoaki, AU - Iwamoto,Yoshihiro, AU - Takeuchi,Hayato, AU - Tsujino,Hitoshi, AU - Hashimoto,Naoya, Y1 - 2019/11/19/ PY - 2019/08/10/received PY - 2019/11/07/revised PY - 2019/11/08/accepted PY - 2019/11/23/pubmed PY - 2020/3/7/medline PY - 2019/11/23/entrez KW - Bridging vein KW - Intracranial chronic subdural hematoma KW - Magnetic resonance imaging KW - Migration KW - Spinal subdural hematoma SP - 472 EP - 476 JF - World neurosurgery JO - World Neurosurg VL - 134 N2 - BACKGROUND: Spinal subdural hematoma (SSDH), which can cause lower back pain, leg pain, and leg weakness, is rare and will usually be associated with a bleeding tendency, trauma, spinal vascular malformation, intraspinal tumor, or iatrogenic invasion. Only a few cases of SSDH after intracranial chronic subdural hematoma (CSDH) have been reported. We report a case of lumbar SSDH in the absence of predisposing factors after reoperation for recurrent intracranial CSDH, which improved with conservative treatment. CASE DESCRIPTION: Approximately 1 month after falling, a 63-year-old woman was experiencing left hemiparesis and impaired orientation that was diagnosed as right intracranial CSDH using computed tomography. Surgical treatment of the CSDH led to immediate improvement of her symptoms. On postoperative day 29, the right CSDH had recurred with left hemiparesis, and successful reoperation relieved the symptoms within a few hours postoperatively. However, 1 day after the second operation, very small acute subdural hematomas in regions along the left tentorium cerebelli and left falx cerebri were found on computed tomography. On day 31, she complained of sitting-induced bilateral radiating lower limb pain. Magnetic resonance imaging on day 34 showed an acute SSDH at the L4-L5 level and a sacral perineural cyst filled with hematoma, although her radiating pain was showing improvement. She was treated conservatively and was discharged without symptoms on day 44. CONCLUSIONS: Although SSDH is rare, it is important for neurosurgeons and physicians to consider the possibility of a SSDH when lower limb pain or paresis occurs after procedures that will result in rapid intracranial pressure alterations such as drainage of an intracranial CSDH. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/31756510/Lumbar_Subdural_Hematoma_Detected_After_Surgical_Treatment_of_Chronic_Intracranial_Subdural_Hematoma_ DB - PRIME DP - Unbound Medicine ER -