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Delayed Development of Spinal Subdural Hematoma Following Cranial Trauma: A Case Report and Review of the Literature.
World Neurosurg. 2020 09; 141:44-51.WN

Abstract

BACKGROUND

Spinal subdural hematomas (SDHs) have been reported secondary to direct trauma or iatrogenic causes associated with coagulopathies. Spinal SDHs found after the development of acute intracranial SDHs, without any evidence of trauma to the spine, are extremely rare. In addition to this rare presentation, there is a lack of consensus regarding whether surgical decompression is the ideal treatment strategy. Depending on the extent of SDH within the spinal canal, surgical decompression may be difficult where diffuse hematoma within the intradural space requires multilevel decompression for treatment.

CASE DESCRIPTION

A 46-year-old man initially presented with an acute cranial SDH following isolated head trauma. After a period of full recovery, he developed delayed lower extremity paraparesis secondary to the formation of a thoracolumbar SDH. This hematoma coincided with resolution of the cranial SDH and likely was due to redistribution of blood from the cranial subdural space into the spinal canal. Given the diffuse multilevel nature of the spread of hematoma and lack of a focal area of compression, he was managed conservatively. He demonstrated small signs of neurologic improvement over several days and regained considerable strength over the following several weeks.

CONCLUSIONS

This report demonstrates a very rare occurrence of a traumatic intracranial SDH migrating into the thoracic and lumbar spine. This case also highlights that despite acute neurologic deficits, conservative management may be a feasible strategy that can result in recovery of neurologic function.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Hsieh JK
Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Colby S
Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA.
Nichols D
Department of Neurosurgery, MetroHealth Medical Center, Cleveland, Ohio, USA.
Kondylis E
Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Liu JKC
Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA; Morsani College of Medicine, University of South Florida, Tampa, Florida, USA. Electronic address: James.liu@moffitt.org.

MeSH

Craniocerebral TraumaDecompression, SurgicalHematoma, Subdural, SpinalHumansMaleMiddle AgedParaparesisTreatment Outcome

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

32450315

Citation

Hsieh, Jason K., et al. "Delayed Development of Spinal Subdural Hematoma Following Cranial Trauma: a Case Report and Review of the Literature." World Neurosurgery, vol. 141, 2020, pp. 44-51.
Hsieh JK, Colby S, Nichols D, et al. Delayed Development of Spinal Subdural Hematoma Following Cranial Trauma: A Case Report and Review of the Literature. World Neurosurg. 2020;141:44-51.
Hsieh, J. K., Colby, S., Nichols, D., Kondylis, E., & Liu, J. K. C. (2020). Delayed Development of Spinal Subdural Hematoma Following Cranial Trauma: A Case Report and Review of the Literature. World Neurosurgery, 141, 44-51. https://doi.org/10.1016/j.wneu.2020.05.158
Hsieh JK, et al. Delayed Development of Spinal Subdural Hematoma Following Cranial Trauma: a Case Report and Review of the Literature. World Neurosurg. 2020;141:44-51. PubMed PMID: 32450315.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Delayed Development of Spinal Subdural Hematoma Following Cranial Trauma: A Case Report and Review of the Literature. AU - Hsieh,Jason K, AU - Colby,Samantha, AU - Nichols,Daniel, AU - Kondylis,Efstathios, AU - Liu,James K C, Y1 - 2020/05/22/ PY - 2020/05/14/received PY - 2020/05/17/accepted PY - 2020/5/26/pubmed PY - 2020/12/22/medline PY - 2020/5/26/entrez KW - Acute subdural hematoma KW - Spinal injuries KW - Traumatic spinal subdural hematoma SP - 44 EP - 51 JF - World neurosurgery JO - World Neurosurg VL - 141 N2 - BACKGROUND: Spinal subdural hematomas (SDHs) have been reported secondary to direct trauma or iatrogenic causes associated with coagulopathies. Spinal SDHs found after the development of acute intracranial SDHs, without any evidence of trauma to the spine, are extremely rare. In addition to this rare presentation, there is a lack of consensus regarding whether surgical decompression is the ideal treatment strategy. Depending on the extent of SDH within the spinal canal, surgical decompression may be difficult where diffuse hematoma within the intradural space requires multilevel decompression for treatment. CASE DESCRIPTION: A 46-year-old man initially presented with an acute cranial SDH following isolated head trauma. After a period of full recovery, he developed delayed lower extremity paraparesis secondary to the formation of a thoracolumbar SDH. This hematoma coincided with resolution of the cranial SDH and likely was due to redistribution of blood from the cranial subdural space into the spinal canal. Given the diffuse multilevel nature of the spread of hematoma and lack of a focal area of compression, he was managed conservatively. He demonstrated small signs of neurologic improvement over several days and regained considerable strength over the following several weeks. CONCLUSIONS: This report demonstrates a very rare occurrence of a traumatic intracranial SDH migrating into the thoracic and lumbar spine. This case also highlights that despite acute neurologic deficits, conservative management may be a feasible strategy that can result in recovery of neurologic function. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/32450315/Delayed_Development_of_Spinal_Subdural_Hematoma_Following_Cranial_Trauma:_A_Case_Report_and_Review_of_the_Literature_ DB - PRIME DP - Unbound Medicine ER -