Korean J Neurotrauma.  2019 Oct;15(2):182-186. 10.13004/kjnt.2019.15.e20.

Spontaneous Intracranial and Spinal Subdural Hematoma: A Case Report

• Kim DG
• Cho YS
• Wang HS
• Kim SW

• KMID: 2461125
• DOI: http://doi.org/10.13004/kjnt.2019.15.e20

Abstract

Spinal subdural hematoma (SDH) is rarely reported, and their simultaneous occurrence with intracranial SDH is even more rare. A 67-year-old male patient with a history of posterolateral fusion to treat an L2 burst fracture came to our outpatient clinic due to an inability to walk by himself over the previous 3 weeks. A neurological examination revealed that the patient was alert with occasional confusion and slight motor weakness in the lower extremities. Brain and lumbar spine magnetic resonance imaging (MRI) was then performed. A brain MRI revealed a large subacute SDH along the right cerebral convexity and falx cerebri with midline shifting, and a spine MRI revealed a right side-predominant subacute SDH extending from L4 to S1. For treatment, burr hole trephination of the intracranial SDH and fluoroscopy-guided lumbar puncture of the spinal SDH were performed and resulted in a favorable outcome. This is a report of a rare case of spontaneous intracranial and lumbar spine SDH. We include a review of the current literature and a discussion of the pathogenesis of this condition in this report.

Keyword

Spine; Brain; Subdural hematoma

MeSH Terms

Aged
Ambulatory Care Facilities
Brain
Hematoma, Subdural
Hematoma, Subdural, Spinal*
Humans
Lower Extremity
Magnetic Resonance Imaging
Male
Neurologic Examination
Spinal Cord
Spinal Puncture
Spine
Trephining

Figure

• 

  FIGURE 1 Lumbar spine MRI images of the patient. Sagittal T1-weighted (A) and T2-weighted (B) images reveal a hematoma (arrows) in the dorsal spine at the L4–S1 level. Axial T1-weighted (C) and T2-weighted (D) images at the L5 level reveal a subacute subdural hematoma. The hematoma is right-side dominant.MRI: magnetic resonance imaging.

• 

  FIGURE 2 Brain MRI images of the patient. Axial T1-weighted (A) and T2-weighted (B) MRI images demonstrate a large right-side subdural hematoma with slight hyperintensity compared to CSF. This MRI finding is typical of subacute SDH.MRI: magnetic resonance imaging, CSF: cerebrospinal fluid, SDH: spinal subdural hematoma.

• 

  FIGURE 3 Dark-brownish blood obtained with fluoroscopy-guided lumbar puncture.

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