Spinal Subdural Hematoma Associated With Traumatic Intracranial Interhemispheric Subdural Hematoma

Abstract

A 78-year-old female fell and hit the back of her head on the floor. Head computed tomography (CT) showed right acute interhemispheric subdural hematoma (ISDH). Her left hemiparesis worsened, so partial removal of ISDH was performed. The hemiparesis was improved, but leg monoparesis persisted. Lumbar magnetic resonance imaging showed spinal subdural hematoma (SSDH) at the S1-2 level. Nerve conduction velocity measurements at the knee joint to lower limb showed disappearance of the left peroneal nerve conduction wave, indicating that one of the causes of drop foot was common peroneal nerve palsy. With conservative therapy, her drop foot was gradually improved, then she recovered to walk with a stick and moved to a rehabilitation hospital. Lumbar MR imaging should be performed to rule out SSDH in a patient with posterior fossa subdural hematoma on initial head CT who develops leg palsy.

Prospective assessment of concomitant lumbar and chronic subdural hematoma: is migration from the intracranial space involved in their manifestation?

“…9,11,18,38,44 Interestingly, among the 17 earlier trauma patients, 7 (41%) also had a bleeding tendency, 1 presented with blood dyscrasia, and 6 were on drug therapy that can affect bleeding. 7,17,20,29,30,40,41 The patient in our Case 1 also had a history of myelo dysplastic syndrome and hemorrhagic diathesis. Russell and Benoit 33 reviewed 58 cases involving patients with spinal SDH and found that in 16%, SDH occurred after anticoagulation therapy.…”

“…The etiology remained unclear in the 35 previously reported cases (Table 1). Of these cases, 3 involved patients who had undergone ventricu loperitoneal (VP) shunt placement, 31,37,42 3 cases were postcraniotomy, 26,36,43 17 were posttrauma, 1,4,5,7,8,13,17,20,21,24,29,30,34,35,[39][40][41] and in 12 cases the SDH arose spontaneous ly. [9][10][11]16,18,22,25,28,30,38,44,45 Leakage of intracranial SDH fluid into the spinal subdural space may be involved in patients who manifest spinal SDH after VP shunt placement.…”

“…Others 1,4,5,7,8,13,17,20,21,24,29,30,34,35,[39][40][41] have speculated that in some of their trauma patients the spinal SDH migrated from the intracranial lesion because the intensity on MR images was the same for both types of hematoma. How ever, the mechanism of migration of the intracranial SDH through the membrane remained unclear.…”

“…Of 29 earlier patients with posttraumatic or spon taneous hematomas, 1,3,5,[7][8][9][10][11]13,[16][17][18][20][21][22]24,25,[28][29][30][31][34][35][36][37][38][39][40][41][42][43][44][45] 11 had undergone surgery, 2 aspiration by lumbar puncture, and 16 had been placed under observation. In both of our pa tients with concomitant asymptomatic spinal SDH the lesions resolved spontaneously with conservative man agement.…”

“…Also, we included only patients with chronic SDH. Al though none of them presented with acute SDH, other authors 1,8,9,16,18,24,29,38,40,41 have encountered patients with concomitant SDH who did. Because we did not acquire brain MRI scans, we could not compare the intensity of the intracranial and lumbar SDH in our 2 patients who had concomitant lesions.…”