Non-traumatic Spontaneous Spinal Subdural Hematoma in a Patient with Acute Paraplegia

Abstract

Acute non-traumatic spinal subdural hematoma (SSDH) is a rare clinical condition in the emergency medicine practice and difficult to diagnose during the primary physical examination. It mostly occurs at thoracal vertebra levels due to trauma, use of anticoagulants, medical procedures such as acupuncture, arteriovenous malformations, hematological disorders or space-occupying lesions. Here, we discussed an elderly female patient who was not on anticoagulant and described sudden loss of muscle strength and sensation in both lower extremities. Initial laboratory and imaging including brain computerized tomography (CT) and magnetic resonance imaging (MRI) were in normal range. Her secondary examination revealed anesthesia under the T4 dermatome level. Cervical spine-MRI imaging revealed a subdural hematoma significantly compressing the spinal cord on the C7-T1 dermatome segments. Any emergency neurosurgical intervention was not considered and the patient was interned in the neurosurgical clinic for conservative treatment and further examination. Patient , with no progress seen in consecutive MRI scans, was discharged after offering an outpatient check-up. We recommend secondary physical examination in emergency department (ED). In the case of appearance of sensory deficits of certain dermatomes, spine-MR imaging may lead to put the diagnose early in ED.

Keywords

• Non-traumatic
• Spinal Subdural Hematoma
• Spontaneous Paraplegia

References

1. Reference1. Pereira BJ, de Almeida AN, Muivo VM, de Oliveira JG, Holanda CV, Fonseca NC. Predictors of outcome in nontramatic spontaneous acute spinal subdural hematoma:case report and literature review. World Neurosurg 2016;89:574-577(e7).
2. Reference2. Kreppel D, Antoniadis G, Seeling W. Spinal Hematoma:a literature survey with meta-analysis of 613 patients. Neurosurg Rev 2003;26:1-49.
3. Reference3. Hsieh CF, Lin HJ, Chen KT, Foo NP, et al. Acute spontaneous cervical spinal epidural hematoma with hemiparesis as the initial presentation. Eur J Emerg 2006;13:36-38
4. Reference4. Küker W, Thiex R, Friese S, Freudenstein D, Reinges MH, Ernemann U, et al.Spinal subdural and epidural hematomas:diagnostic and therapeutic aspects in acute and subacute cases. Acta Neurochir 2000;142:777-785.
5. Reference5. Robert G, Lehman RA, Kuhlengel KR. Cervical spinal epidural haetoma:the double jeopardy. Ann Med 1996;28:407-411.
6. Reference6. Jung-Hwan Oh, Seung-JooJwa, Tae Ki Yang, et al. Intracranial Vasospasm without Intracranial Hemorrhage due to Acute Spontaneous Spinal Subdural Hematoma. Exp Neurobiol 2015;24(4):366-370.
7. Reference7. Dargazanli C., Lonjon N., Gras-Combe G. Nontraumatic spinal subdural hematoma complicating direct factor Xa inhibitor treatment (rivoroxaban):a challenging management. Eur Spine J. 2015;25:100-103.
8. Reference8. Payer M., Agosti R. Spontaneous acute spinal subdural hematoma:spontaneous recovery from severe paraparesis-case report and review. ActaNeurochir 2010;152(11):1981-1984.

9. Reference9. Calhoun JM., Boop F. Spontaneous spinal subdural hematoma:case report and review of the literature. Neurosurgery 1991;29(1):133-134.
10. Reference10. Oh SH., Han IB., Koo YH., Kim OJ. Acute spinal subdural hematoma presenting with spontaneously resolving hemiplegia. J. Korean Neurosurg Soc. 2009;45(6):390-393.