Spinal Intradural Hematoma after Spinal Anesthesia in a Young Male Patient: Case Report and Review of the Literature

Abstract

Spinal intradural hematoma (SIH) is a rare condition which can cause neurological sequelae such as permanent motor weakness and sensory loss in the lower extremities. Herein, we describe a case of SIH following spinal anesthesia. The patient was a 30-year-old man who underwent treatment for accessory navicular syndrome at our department. The patient was not receiving anticoagulation therapy, and spinal anesthesia was thus selected. No symptoms of hematoma were observed in the immediate postoperative period, but the patient complained of pain in both buttocks on postoperative day 5. However, neither motor weakness nor sensory loss were observed. Additionally, as the radiating pain extending to the lower extremities typical of neurological pain was not observed, musculoskeletal pain was suspected. Magnetic resonance imaging revealed intradural hematomas at L4-5 and S1. Conservative treatment and follow-up evaluations were performed to ensure that additional neurological sequelae did not occur. Six months after symptom onset, his pain Numeric Rating Scale score was 0, and no other neurological findings were observed. However, in patients who undergo spinal anesthesia, localized pain in the back without other neurological symptoms and lack of radiating pain may be associated with more than musculoskeletal pain. Such patients must be continuously monitored.

Spinal Subdural Hematoma following Epidural Anesthesia

“…However, Rettenmaier et al 9 argue that superior results with conservative management in SSDHs reflect a selection bias as only patients who have severe deficits are offered surgery, while those who are preserved neurologically are usually managed with medications. Conversely, Ji et al 4 state that there is a 63.6% chance of developing permanent deficits and sphincter loss in those who have neurological symptoms but do not undergo surgery as opposed to such poor outcomes in only 17.9% in cases with symptoms who undergo surgery and advocate intervention as soon as possible as was done in this instance.…”

“…They also state that among all spinal hematomas caused by LPs epidural hematoma is the commonest (75%), while subarachnoid hematoma and SSDH account for 15.7 and 4.1%, respectively. 4 Kreppel et al 5 too reported only 25 cases (4%) of SSDHs in a meta-analysis of 613 patients of spinal hematomas with varying etiologies.…”

“…The first clinically diagnosed SSDH was described by Robert Jackson in 1869 3 who called it “spinal apoplexy” in the cervical spine and was confirmed later by postmortem examination in a 14 years old girl who died following rapidly progressive quadriplegia and respiratory failure. While SSDHs can be a result of LP, spinal tumors, spinal vascular malformations, spinal surgery, anticoagulation therapy, and bleeding diathesis, Ji et al 4 state that LP is the rarest cause of any spinal hematoma, with an incidence of less than 1%. They also state that among all spinal hematomas caused by LPs epidural hematoma is the commonest (75%), while subarachnoid hematoma and SSDH account for 15.7 and 4.1%, respectively.…”

Cervical spinal cord compression from subdural hematoma caused by traumatic nerve root avulsion: illustrative case

“…Prior studies have examined spinal intradural hematomas as a result of trauma, iatrogenic causes, spinal anesthesia, or coagulopathy, though the exact etiology for these hemorrhages can remain unknown in a nontrivial percentage of cases. 1,[5][6][7][8][9] Furthermore, the distribution of hematoma location follows a relatively bimodal distribution, clustering in the cervical spine and the lower thoracic spine. 1 To our knowledge, an example of cervical intradural hematoma associated with traumatic nerve root avulsion has not been published since 1980.…”