Predictors of Outcome in Nontraumatic Spontaneous Acute Spinal Subdural Hematoma: Case Report and Literature Review

Pereira, Benedito Jamilson Araújo; Almeida, Antônio Nogueira de; Muio, Valéria Marques F.; Oliveira, Jean Gonçalves de; Holanda, Carlos Vanderlei M. de; Fonseca, N.C.

doi:10.1016/j.wneu.2015.11.010

Cited by 40 publications

(65 citation statements)

References 75 publications

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“…Although spontaneous spinal subdural hematoma (sSDH) is a rare condition, it is associated with significant morbidity and mortality [ 1 ]. Exceedingly less common are spontaneous sSDHs occurring in the absence of an identifiable etiology.…”

Section: Introductionmentioning

confidence: 99%

“…A nearly equivalent incidence between males and females has been described, but given the rarity of spontaneous sSDH the exact incidence remains unknown [ 2 ]. While spontaneous sSDHs are most frequently described in association with coagulopathies, iatrogenic causes, or arteriovenous malformations [ 1 ], the pathogenesis of spontaneous sSDH largely remains unclear. Rupture of the vasculature within the subarachnoid or subdural space has been proposed as a potential pathogenic mechanism in certain cases.…”

Section: Introductionmentioning

confidence: 99%

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Acute, Nontraumatic Spontaneous Spinal Subdural Hematoma: A Case Report and Systematic Review of the Literature

Rettenmaier

Holland

Abel

2017

Case Reports in Neurological Medicine

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Spontaneous spinal subdural hematoma (sSDH) is a rare condition outright. Moreover, cases that occur spontaneously in the absence of an identifiable etiology are considerably less common and remain poorly understood. Here, we present the case of a 43-year-old man with spontaneous sSDH presenting with acute onset low back pain and paraplegia. Urgent magnetic resonance imaging identified a dorsal SDH from T8 to T11 with compression of the spinal cord. Emergent T8–T10 laminectomies with intradural exploration and hematoma evacuation were performed. However, despite prompt identification and appropriate action, the patient's recovery was modest and significant disability remained at discharge. This unique and unusual case demonstrates that spontaneous sSDH requires prompt surgical treatment to minimize associated morbidity and supports the association between the presence of severe neurological deficits upon initial presentation with less favorable outcomes. We performed a comprehensive systematic review of spontaneous sSDH of unknown etiology, which demonstrates that emergent surgical intervention is indicated for patients presenting with severe neurological deficits and the presence of these deficits is predictive of poor neurological outcome. Furthermore, conservative management should be considered in patients presenting with mild neurological deficits as spontaneous resolution followed by favorable neurological outcomes is often observed in these patients.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Acute, Nontraumatic Spontaneous Spinal Subdural Hematoma: A Case Report and Systematic Review of the Literature

Rettenmaier

Holland

Abel

2017

Case Reports in Neurological Medicine

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“…A nontraumatic spontaneous acute spinal subdural hematoma (sSDH) is a rare condition with a morbidity rate of 28% based on permanent neurologic deficits or death. 1 Few cases have been reported about acute sSDH complicating spinal surgery, [2][3][4] especially without dural trauma. 5,6 Although an sSDH is often associated with anticoagulation therapy, vascular malformations, or lumbar puncture, the pathogenesis remains unclear.…”

Section: Introductionmentioning

confidence: 99%

An Acute Spinal Intradural Hematoma after an Extraforaminal Wiltse Approach: A Case Report and Review of the Literature

Raymaekers

Beck

Goebel

et al. 2020

J Neurol Surg A Cent Eur Neurosurg

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A nontraumatic spontaneous spinal acute subdural hematoma (sSDH) is a rare complication after spinal surgery. Although an sSDH is often associated with anticoagulation therapy, vascular malformations, or lumbar puncture, the pathogenesis of nontraumatic spontaneous sSDH remains unclear. We present the case of an intradural hematoma after an extraforaminal surgery through the Wiltse approach for an extraforaminal disk herniation at L5/S1. This 58-year-old woman experienced hypoesthesia and progressive motor dysfunction in the left leg several hours postoperation. Urgent magnetic resonance imaging revealed an intradural hematoma at the L1/L2 to L2/L3 level in the ventral dural sac proximal to the surgical level. Surgical decompression was performed. There was no evidence of trauma, coagulopathy, or anticoagulation therapy. To our knowledge, this case is the first to report an acute sSDH proximal to the surgery level after an extraforaminal spinal surgery through the Wiltse approach for an extraforaminal disk herniation. It illustrates that attentive postoperative neurologic monitoring, even in the absence of intraoperative irregularities, remains important to diagnose and treat this complication at the early stage.

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“…More generally, concerning spinal hematoma, prognosis is better when painfree interval is shorter, neurological deficits milder, delay to surgery shorter [2]. Absence of coagulopathy seems to lead to a better prognosis for SSDH [9]. No correlation seems to appear between prognosis and extent of the hemorrhage.…”

mentioning

confidence: 96%

“…This type of information can convince the surgeon to operate on even in cases with mild neurological impairment. Mortality rate is 1.3% and morbidity rate 28% [9]. More generally, concerning spinal hematoma, prognosis is better when painfree interval is shorter, neurological deficits milder, delay to surgery shorter [2].…”

mentioning

confidence: 99%

A Commentary on 'Acute Non-traumatic Spinal Subdural Hematomas'

Pl¹,

Morandi²

2017

Int J Neurorehabilitation Eng

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Predictors of Outcome in Nontraumatic Spontaneous Acute Spinal Subdural Hematoma: Case Report and Literature Review

Cited by 40 publications

References 75 publications

Acute, Nontraumatic Spontaneous Spinal Subdural Hematoma: A Case Report and Systematic Review of the Literature

Acute, Nontraumatic Spontaneous Spinal Subdural Hematoma: A Case Report and Systematic Review of the Literature

An Acute Spinal Intradural Hematoma after an Extraforaminal Wiltse Approach: A Case Report and Review of the Literature

A Commentary on 'Acute Non-traumatic Spinal Subdural Hematomas'

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