Spinal subdural hematoma presenting as an epidural hematoma following gunshot wound: report of a case

A man with a gunshot wound to the lumbar spine presented with leg weakness and paresthesias. Although the preoperative myelogram suggested an epidural compressive mass, a subdural hematoma was found at surgery. In addition to the case presentation, the literature was also reviewed.     

Spinal subdural hematoma following intracranial aneurysm surgery: four case reports

Four patients presented with rare spinal subdural hematoma (SDH) occurring after intracranial aneurysm surgery and manifesting as postoperative back pain. Magnetic resonance imaging performed from 4 to 11 days after the operation showed acute or subacute thoracolumbar SDH. No patient had risk factors for bleeding at this site (e.g., lumbar puncture, coagulation abnormality). Overdrainage of the cerebrospinal fluid (CSF) was performed for brain retraction during the operation in all four cases. Computed tomography performed during the postoperative period showed a suspicious tentorial subdural hemorrhage in Case 1 and an interhemispheric subdural hemorrhage in Case 3. All four patients received conservative management and their lumbago improved. We hypothesize that CSF hypotension due to overdrainage of CSF and downward migration of intracranial SDH under the influence of gravity were involved in the formation of spinal SDH.     

Spinal subdural hematoma: case report and review of the literature.

A case of lumbar spinal subdural hematoma in a patient who had been on anticoagulant therapy is reported. Thus far 19 cases of spinal subdural hematoma have been reported in the literature, the majority in patients with a bleeding diathesis and after a lumbar puncture. Our case is the third reported to be in association with anticoagulant therapy. The hematoma was lumbosacral, in contrast to the usual location in the dorsal-lumbar area. A possible mechanism for the production of spinal subdural hematoma after a lumbar puncture is discussed. An early decompressive laminectomy and evacuation of the hematoma is the recommended treatment to obtain the best possible recovery of neurological function. (Neurosurgery, 5: 614--616, 1979).     

Intracranial hypotension with subdural hematoma following lumbar puncture: case report

BACKGROUND AND PURPOSE: Lumbar puncture is a common procedure highly contributive to neurological diagnosis. It can also cause serious adverse side effects including subdural hematoma and intracranial hypotension as illustrated by this case report. CASE REPORT: A 38-year-old women presented severe intracranial hypotension after a lumbar puncture. Magnetic resonance imaging was compatible with intracranial hypotension and revealed an acute subdural hematoma with midline deviation. A first blood patch was unsuccessful. Symptom relief was achieved with a second patch. The patient was, then, discharged but developed recurrent headache subsequent to the transformation from acute to chronic subdural hematoma. Surgical drainage was required. The postoperative imaging and physical examination returned to normal and the patient was discharged with no recurrence. CONCLUSION: The serious adverse effects of lumbar puncture is an easy and common medical procedure that must be kept in mind.     

Ossified chronic subdural hematoma: case report

A case of ossified chronic subdural hematoma is presented in a 13-year-old male in whom the mass was surgically removed. His neurological deficits continued afterward but were less severe.     

Spinal epidural hematoma following epidural anesthesia versus spontaneous spinal subdural hematoma. Two case reports

Two cases of lumbar hemorrhage with subsequent persistent neurologic sequelae are presented and their possible causes are discussed in the context of a literature review: one patient with spontaneous spinal subdural hematoma with no trauma or lumbar puncture and one with spinal epidural hematoma associated with preceding epidural catheterization for postoperative pain relief. The subdural hematoma was associated with a thrombocytopenia of about 90,000/microliters due to intraoperative blood loss. This might have been contributory to the formation or expansion of the hematoma, but it is not convincing since a platelet count of this amount should not lead to spontaneous bleeding. Both patients received low-dose heparin, but since coagulation tests were normal, prolonged bleeding does not appear to be a likely cause, although it cannot be excluded. In conclusion, the reasons for both hematoma remain unclear. With regard to the epidural hematoma and low-dose heparinization, the possible coincidence of spontaneous lumbar hematoma and lumbar regional block should be taken into consideration.     

Burr-hole craniotomy treating chronic subdural hematoma: a report of 398 cases

Objective： To investigate the treatment of chronic subdural hematoma （CSDH） with burr-hole craniotomy in our hospital. Methods： From January 2004 to December 2009, 398 patients with CSDH, 338 males and 60 females （male/ female=5.63/1）, received burr-hole craniotomy in our hospital. The median age was 60 years with the mean age of （58.1± 18.1） years, （65.0±14.5） years for females and （57.0± 8.2） years for males. Trauma history was determined in 275 patients （69.1%）. Burr-hole craniotomy was performed under local anesthesia in 368 patients and general anesthesia in 30 patients. CSDH was classified into 3 groups according to the density on CT scan. Clinical data concerning etiologies, symptoms and signs, concomitant diseases, diagnosis, therapies and outcomes were investigated retrospectively. Patients＇ neu- rological status on admission and at discharge was also classified to judge the outcomes. Results： Generally, trauma history showed few dif- ferences between those over 60 years old and under 60 years old, but showed obvious differences when gender was taken into account. Totally 123 male patients （60.0% of 204 cases） suffering from head injuries were under 60 years, whereas 35 female patients （85.4% of 41 cases） with trauma histories were over 60 years. The duration from trauma to appearance of clinical symptoms was （84.0±61.7） days （range, 0-1493 days）. Traumatic accident was the leading etiology, other accompanying diseases such as cerebral vascular disease, hypertension, etc, were also predisposing factors. Commonly, the elderly presented with hemiplegia/ hemidysesthesia/hemiataxia and the young with headache. Most CSDH patients （95.6%） treated with burr-hole cran- iotomy successfully recovered. However, postoperative complications occurred in 17 cases, including recurrence of CSDH in 15 cases, subdural abscess in 1 case and pneumonia in 3 cases. Conclusion： Burr-hole craniotomy is an easy, efficient and reliable way to treat CSDH.     

Spinal chronic subdural hematoma

Although chronic subdural hematomas are rare, they are likely to be more frequently reported as the clinical and magnetic resonance imaging characteristics become defined. Chronic spinal subdural hematomas (CSSDH) are extremely rare; these hematomas are frequently spontaneous and related to minor trauma. Although generally said to carry a poor prognosis, CSSDH can be a reversible cause of paraplegia. This article reviews the history, classification, clinical presentation, and treatment of CSSDH.     

自发性脊柱硬膜下血肿1例报告

脊柱硬膜下血肿（SSDH）是一种罕见且危险的椎管内血肿，可表现为神经根痛、截瘫、自主神经功能障碍等脊髓横贯性损伤，极少数表现为单侧病变。好发于胸椎，腰椎少见。2021年4月5日，本院收治1例自发性SSDH患者，疗效满意，现报告如下。     

Spinal subdural hematoma formation following ventriculoperitoneal shunting for hydrocephalus

Summary A case of a 14-year-old girl who developed a spinal subdural hematoma after placement of a ventriculoperitoneal shunt is presented. Such a complication has not been previously reported. We believe that this represented an extension of intracranial subdural hematoma fluid into the spinal subdural space.     

Spinal epidural hematoma following coronary thrombolysis. A case report

A case of cervicothoracic spontaneous spinal epidural hematoma (SSEH) following coronary thrombolysis with r-TPA and intravenous heparin is reported. The clinical picture is discussed, as well as the importance of rapid neuroradiological diagnosis (with spinal MRI being the method of choice) and surgical treatment. Anyway, in these patients, thorough cardiac function evaluation and rapid correction of any clotting disorder is necessary prior to surgery. With the increasing use of fibrinolytic therapy this complication would be more frequent. This underlines the importance of prompt recognition and adequate treatment.     

Acute interhemispheric subdural hematoma: a case report with good result by small craniotomy during the chronic stage

A 88-year-old male slipped down and hit his head on the floor on the night of November 27, 1988. He was able to return to bed and fell asleep. Next morning, he noticed gait disturbance and was admitted to our clinic. Neurological examination revealed monoparesis (1/5) and hyperreflexia of the left lower extremity. Computed tomography (CT) demonstrated a semilunar high density area with the base toward the right side of the falx. General anesthesia for craniotomy was judged to be contra-indicated because serious ischemic heart disease was also present. Although his neurological condition proved to be not progressive, and the monoparesis recovered gradually under conservative treatment, he could not walk by himself one month after the accident. Since the hematoma was surmised to be liquidized and, hence, could be aspirated either through a burr hole or by small craniotomy, an operation was performed under local anesthesia on January 4th, 1989. The hematoma was successfully removed, and the muscle power of the extremities improved to the level of 4/5 - 5/5 just after operation. He was discharged on foot. Lately, there seems to be an increase in patients with traumatic intra-cranial hematomas who, because of systemic problems related to advanced age, are regarded as high-risk subjects for craniotomy under general anesthesia. Not a few of these patients have residual neurological deficits, even though they are in a chronic stage. The subject of this case reported here is typical of such patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

Intracranial subdural hematoma following spinal anesthesia: case report and review of the literature

Postdural puncture headaches represent one of the main complications of spinal anesthesia. Sometimes, they can reveal the presence of an intracerebral hemorrhage or intracranial subdural hematoma. Atypical postdural puncture headaches or secondary alterations of a typical headache, and particularly the disappearance of its postural character, must prompt to search for another cause. Early diagnosis and careful and rapid management are mandatory. We here report the case of a 53-year-old woman who presented with an intracranial subdural hematoma following spinal anesthesia for hallux valgus surgery performed 48 hours earlier. The implications of such a diagnosis are then discussed, in the light of the existing literature.     

Lumbar spinal subdural hematoma following craniotomy--case report.

A 52-year-old female complained of lumbago and weakness in the lower extremities 6 days after craniotomy for clipping an aneurysm. Neurological examination revealed symptoms consistent with lumbosacral cauda equina compression. The symptoms affecting the lower extremities spontaneously disappeared within 3 days. Magnetic resonance (MR) imaging 10 days after the operation demonstrated a lumbar spinal subdural hematoma (SSH). She had no risk factor for bleeding at this site, the symptoms appeared after she began to walk, and MR imaging suggested the SSH was subacute. Therefore, the SSH was probably due to downward movement of blood from the cranial subdural space under the influence of gravity. SSH as a complication of cranial surgery is rare, but should be considered if a patient develops symptoms consistent with a lumbar SSH after craniotomy.