J Korean Orthop Assoc.  2013 Oct;48(5):397-401. 10.4055/jkoa.2013.48.5.397.

Traumatic Lumbosacral Spinal Subdural Hematoma Mimicking Subdural Lipoma: Value of Computed Tomography

• Hwang SC
• Kim HK
• Cho SH
• Nam DC
• Lee HK
• Park KE
• Na JB
• Kim DH

• KMID: 1494153
• DOI: http://doi.org/10.4055/jkoa.2013.48.5.397

Abstract

Traumatic lumbosacral spinal subdural hematoma due to anatomical and pathological causes is rare, compared to epidural hematoma. If the time of trauma cannot be determined, intracranial and intraspinal signal intensity according to lapse of time are not coincident, resulting in confusion in terms of differentiation. Fat suppression magnetic resonance image (MRI) and computed tomography (CT) are utilized for differentiation. The intention of this study is to report on a case where spinal subdural hematoma of unknown time of occurrence is differentiated from subdural lipoma by taking advantage of fat suppression MRI and CT in order to perform an early surgical decompression with auxiliary review of literature demonstrating good prognosis of the procedure.

Keyword

lumbosacral spinal subdural hematoma; subdural lipoma; surgical decompression

MeSH Terms

Decompression, Surgical
Hematoma
Hematoma, Subdural, Spinal*
Intention
Lipoma*
Magnetics
Magnets
Prognosis

Figure

• 

  Figure 1 Preoperative radiographs. (A) Posteroanterior and (B) lateral plain radiographs showed endplate sclerotic changes and osteophytes of the lumbar spine.

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  Figure 2 (A) T1 weight image sagittal magnetic resonance image (MRI) demonstrating a hyperintense signal (B) T2 weight image sagittal MRI demonstrating an intermediate to low signal from L1 to S2 level suggestive of a subdural hematoma causing thecal sac compression (arrows). Axial (C) T1 and (D) T2-weighted MRI showing signal intensity, correlating with an early subacute subdural hematoma at the anterior and posterior location of the spinal canal (asterisk points: 'inverted Mercedes sign').

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  Figure 3 Preoperative computed tomography (A: upper doted line on C, B: lower doted line on C) different axial level view and (C) sagittal view showing differences in signal density between the hematoma (isodensity) and epidural fat (low density, arrows).

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  Figure 4 (A) Lumbar 4-5 level puncture. (B) Hematoma mixed with cerebrospinal fluid was aspirated by 3 ml.

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  Figure 5 (A) After total laminectomy of L4 and L5, a dark-reddish transparent hematoma was observed beneath the dura. (B) Bleeding was observed around the right L4 root which may be considered a valveless radiculomedullary vein, and it was coagulated with bipolar bovie.

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  Figure 6 Magnetic resonance images taken three months after surgery (A: upper doted line on C, B: lower doted line on C). T2-weight axial images demonstrate recovery of normal signal density without thecal sac compression. (C) T2-weight sagittal image showing disappearance of the subdural hematoma.

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