Spinal subarachnoid hematomas

Abstract

Although damage to the veins of Batson's epidural plexus is usually considered the origin of bleeding in traumatic lumbar puncture, a lesion of these veins would not explain the cases in which postmortem examination shows blood confined to the subdural and subarachnoid spaces. In two patients who had lumbar punctures a few days before death, there was subarachnoid hematoma of the cauda equina at autopsy. In one of these cases, the radicular vessels were shown to be the source of bleeding. Spinal subarachnoid and subdural hemorrhages after lumbar puncture may be due to laceration of radicular vessels by the spinal needle.

Spinal subdural hematoma: a rare case of spinal subdural hematoma complicating routine, minimally invasive lumbar discectomy and decompression and relevant literature review

“…Some authors have proposed that blood products can be traumatically introduced into the subdural by rupturing either a radicular artery accompanying a nerve root or disrupting the epidural plexus of Batson (less likely given its lateral positioning), attracting further fluid by creating an osmotically favorable gradient and negative hydrostatic pressure driving fluid extravasation into this space (19,27,(29)(30)(31). Bleeding and extravasation of fluid into the subdural space may be exacerbated by alterations in intraabdominal or intrathoracic pressure leading to additional vessel rupture, even in a delayed fashion (22,31).…”

Spontaneous Spinal Subarachnoid Hemorrhage with Spontaneous Resolution

“…In rare cases, they may be spontaneous 3,7,14,17) . Some authors believe that the causes of bleeding are rupture of the arteries and radicular veins, especially in iatrogenic SSHs 10) . Another theory is that the SSH may originate from primarily within the subarachnoid space.…”

“…Another theory is that the SSH may originate from primarily within the subarachnoid space. The spinal arachnoid mater is a connec- tive tissue membrane closely attached to the dura mater and reflected off the surface of the spinal cord to ensheath blood vessels as they transverse the subarachnoid space 10) . In the case of a sudden rapid increase of abdominal or thoracic pressure, these are responsible for similar pressure variations in the spinal canal with rupture of the vessels, particularly the valveless radiculomedullary veins that cross the subdural and subarachnoid space.…”

Lumbosacral Subdural Hematoma-Case Report-

“…One theory is that the SSH might originate in the subarachnoid space, dissect the arachnoid membrane, and spread into the subdural space. 3,12) The blood could be dissipated by the CSF faster in the subarachnoid space than in the subdural space. However, only one report has described bleeding from the subarachnoid space into the subdural space, namely from the radicular vein, as confirmed at the autopsy of a patient who had undergone lumbar puncture.…”