J Korean Neurosurg Soc.  2015 Oct;58(4):397-400. 10.3340/jkns.2015.58.4.397.

Spinal Subdural Hematoma Associated with Intracranial Subdural Hematoma

• Kim MS
• Sim SY

• KMID: 2114381
• DOI: http://doi.org/10.3340/jkns.2015.58.4.397

Abstract

The simultaneous occurrence of an intracranial and a spinal subdural hematoma (SDH) is rare. We describe a case of cranial SDH with a simultaneous spinal SDH. An 82-year-old woman visited the emergency room because of drowsiness and not being able to walk 6 weeks after falling down. A neurological examination showed a drowsy mentality. Brain computed tomography showed bilateral chronic SDH with an acute component. The patient underwent an emergency burr-hole trephination and hematoma removal. She exhibited good recovery after the operation. On the fourth postoperative day, she complained of low-back pain radiating to both lower limbs, and subjective weakness of the lower limbs. Spine magnetic resonance imaging revealed a thoracolumbosacral SDH. A follow-up spinal magnetic resonance imaging study that was performed 16 days later showed a significant decrease in the size of the spinal SDH. We discuss the pathogenesis of this simultaneous occurrence of spinal and cranial SDH.

Keyword

Brain; Spine; Trauma; Subdural hematoma

MeSH Terms

Aged, 80 and over
Brain
Emergencies
Emergency Service, Hospital
Female
Follow-Up Studies
Hematoma
Hematoma, Subdural
Hematoma, Subdural, Intracranial*
Hematoma, Subdural, Spinal*
Humans
Lower Extremity
Magnetic Resonance Imaging
Neurologic Examination
Sleep Stages
Spine
Trephining

Figure

• 

  Fig. 1 Brain computed tomography demonstrates bilateral chronic subdural hematomas with an acute component located in both frontotemporoparietal areas. No hematoma was found in the posterior fossa or tentorium. A : Axial image. B : Coronal image.

• 

  Fig. 2 Magnetic resonance images obtained on the fourth postoperative day showing a spinal subdural hematoma. T2- and T1-weighted images show the high signal intensity of the lesion that was typical of extracellular methemoglobin, which is suggestive of late subacute or early chronic hematoma. The hematoma is separated from the posterior epidural fat by the dura mater and is located in the ventral and dorsal subdural space (red arrow). Moreover, this hematoma determines the mass effect on the nerve root of the cauda equina, leading to a "3-branch star" appearance (yellow arrow). A : T2-weighted sagittal image. B : T1-weighted sagittal image. C : T2-weighted axial image.

• 

  Fig. 3 T1-weighted magnetic resonance imaging performed 20 days postoperatively shows a decreased spinal subdural hematoma.

Reference

1. Calhoun JM, Boop F. Spontaneous spinal subdural hematoma : case report and review of the literature. Neurosurgery. 1991; 29:133–134. PMID: 1870675.

2. Chen HJ, Liang CL, Lu K, Liliang PC, Tsai YD. Cauda equina syndrome caused by delayed traumatic spinal subdural haematoma. Injury. 2001; 32:505–507.

3. Cho DC, Sung JK. Traumatic subacute spinal subdural hematoma successfully treated with lumbar drainage : case report. J Spinal Disord Tech. 2009; 22:73–76. PMID: 19190440.

4. Cohen JE, Eger K, Montero A, Israel Z. Rapid spontaneous resolution of acute subdural hematoma and HIV related cerebral atrophy : case report. Surg Neurol. 1998; 50:241–244.

5. Hagihara N, Abe T, Kojima K, Watanabe M, Tabuchi K. Coexistence of cranial and spinal subdural hematomas : case report. Neurol Med Chir (Tokyo). 2010; 50:333–335. PMID: 20448430.

6. Hausmann O, Kirsch E, Radü E, Mindermann TH, Gratzl O. Coagulopathy induced spinal intradural extramedullary haematoma : report of three cases and review of the literature. Acta Neurochir (Wien). 2001; 143:135–140. PMID: 11459084.

7. Lee JI, Hong SC. Spinal subdural haematoma as a complication of cranial surgery. Acta Neurochir (Wien). 2003; 145:411–414. discussion 414-415PMID: 12820049.

8. Lee TH, Su TM, Wang KW, Lee HL, Ho JT. Lumbosacral spinal subdural hematoma following burr hole craniotomy : case report and literature review. Clin Neurol Neurosurg. 2007; 109:282–286. PMID: 17169484.

9. Masdeu JC, Breuer AC, Schoene WC. Spinal subarachnoid hematomas : clue to a source of bleeding in traumatic lumbar puncture. Neurology. 1979; 29:872–876. PMID: 572011.

10. Miller DR, Ray A, Hourihan MD. Spinal subdural haematoma : how relevant is the INR? Spinal Cord. 2004; 42:477–480. PMID: 14968105.

11. Morishige M, Abe T, Ishii K, Fujiki M, Kobayashi H, Karashima A, et al. Spontaneous chronic head and spinal subdural haematoma. Acta Neurochir (Wien). 2007; 149:1081–1082. discussion 1082PMID: 17665089.

12. Moscovici S, Paldor I, Ramirez de-Noriega F, Itshayek E, Shoshan Y, Spektor S, et al. Do cranial subdural hematomas migrate to the lumbar spine? J Clin Neurosci. 2011; 18:563–565. PMID: 21257311.

13. Moussallem CD, El-Yahchouchi CA, Charbel AC, Nohra G. Late spinal subdural haematoma after spinal anaesthesia for total hip replacement. J Bone Joint Surg Br. 2009; 91:1531–1532. PMID: 19880902.

14. Rader JP. Chronic subdural hematoma of the spinal cord : report of a case. N Engl J Med. 1955; 253:374–376. PMID: 13244833.

15. Riley CA, Spiegel JE. Complications following large-volume epidural blood patches for postdural puncture headache. Lumbar subdural hematoma and arachnoiditis : initial cause or final effect? J Clin Anesth. 2009; 21:355–359. PMID: 19700281.

16. Sánchez-Menoyo JL, Ruiz-Ojeda J, Martínez-Arroyo A, García-Moncó JC, Aduna-De Paz M, Vicente-Olabarría I. [Spinal cord hemorrhage complicating diagnostic lumbar puncture]. Rev Neurol. 2009; 48:418–420. PMID: 19340782.

17. Singh DK, Chauhan M, Gupta V, Chopra S, Bagaria HR. Spinal subdural hematoma : a rare complication of spinal anesthesia : a case report. Turk Neurosurg. 2008; 18:324–326. PMID: 18814128.

18. Tsui EY, Fai Ma K, Cheung YK, Chan JH, Yuen MK. Rapid spontaneous resolution and redistribution of acute subdural hematoma in a patient with chronic alcoholism : a case report. Eur J Radiol. 2000; 36:53–57. PMID: 10996759.

19. Yamaguchi S, Kurisu K, Arita K, Takeda M, Tani I, Araki O. Simultaneous cranial and spinal subdural hematoma. Neurol Med Chir (Tokyo). 2005; 45:645–649. PMID: 16377954.