J Korean Neurosurg Soc.  2015 May;57(5):371-375. 10.3340/jkns.2015.57.5.371.

Spontaneous Spinal Subdural Hematoma with Simultaneous Cranial Subarachnoid Hemorrhage

• Jung HS
• Jeon I
• Kim SW

• KMID: 1881736
• DOI: http://doi.org/10.3340/jkns.2015.57.5.371

Abstract

Spontaneous spinal subdural hematoma is reported at a rare level of incidence, and is frequently associated with underlying coagulopathy or those receiving anticoagulant or antiplatelet agents; some cases accompany concomitant intracranial hemorrhage. The spontaneous development of spinal subdural hemorrhage (SDH) is a neurological emergency; therefore, early diagnosis, the discontinuation of anticoagulant, and urgent surgical decompression are required to enable neurological recovery. In this report, we present a simultaneous spinal subdural hematoma and cranial subarachnoid hemorrhage, which mimicked an aneurysmal origin in a female patient who had been taking warfarin due to aortic valve replacement surgery.

Keyword

Spontaneous; Spinal subdural hematoma; Subarachnoid hemorrhage

MeSH Terms

Aneurysm
Aortic Valve
Decompression, Surgical
Early Diagnosis
Emergencies
Female
Hematoma, Subdural
Hematoma, Subdural, Spinal*
Humans
Incidence
Intracranial Hemorrhages
Platelet Aggregation Inhibitors
Subarachnoid Hemorrhage*
Warfarin
Platelet Aggregation Inhibitors
Warfarin

Figure

• 

  Fig. 1 Axial non-contrast brain computed tomography (CT) image on admission shows a subarachnoid hemorrhage on the bilateral Sylvian and interhemispheric fissures with an intraventricular hemorrhage on the third and fourth ventricles.

• 

  Fig. 2 Sagittal [T1-weighted (A) and T2-weighted (B)] and axial [T1-weighted (C) and T2-weighted (D) on the T5 level] magnetic resonance imaging reveal a large subdural hematoma extending from C7 to T6 compressing the spinal cord (white arrows).

• 

  Fig. 3 An image of the operative field under a microscope; after a total laminectomy on C7-T6, the dura was opened longitudinally, which revealed a dark-colored blood clot compressing the spinal cord.

• 

  Fig. 4 The follow-up sagittal [T1-weighted (A) and T2-weighted (B)] and T2-weighted axial [on the T3 (C) and T5 level (D)] magnetic resonance imaging reveal malatic changes of the spinal cord surrounded by the abundant cerebrospinal fluid on T2-5 (8 months postoperatively).

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