Spontaneous spinal subdural hematoma in COVID-19 patient: Croatian national COVID hospital experience

Abstract

Background: Spontaneous spinal subdural hematoma (SSDH) is a rare condition and causes of acute spinal cord compression, with symptoms varying from mild to severe neurological deficit. SSDH could occur as a consequence of posttraumatic, iatrogenic, or spontaneous causes, including underlying arteriovenous malformations, tumors, or coagulation disorder. Due to its rarity, it is difficult to establish standardized treatment. We present a rare case of SSDH in COVID-19 patient and course of treatment in COVID hospital. Case Description: A 71-year-old female patient was admitted due to instability, weakness of the left leg, and intensive pain in the upper part of thoracic spine as well as mild respiratory symptoms of COVID-19. She was not on pronounced anticoagulant therapy and her coagulogram at admission was within normal range. MRI revealed acute subdural hematoma at the level C VII to Th III compressing the spinal cord. The patient underwent a decompressive Th I and Th II laminectomy and hematoma evacuation. Post-operative MRI revealed a satisfactory decompression and re-expansion of the spinal cord. COVID-19 symptoms remained mild. Conclusion: SSDH represents a neurological emergency, possibly leading to significant deficit and requires urgent recognition and treatment. One of the main difficulties when diagnosing is to consider such condition when there is no history of anticoagulant treatment or previous trauma. Since high incidence of coagulation abnormalities and thromboembolic events was described COVID-19 patients, when considering the pathology of the central nervous system, the bleeding within it due to COVID-19 should be taken into account, in both brain and spine.

An Unusual Case of Acute Scrotal Pain

“…sSDH is a rare phenomenon [7][8][9][10] that most often is associated with coagulopathy [7,8,11]. Only a few reports have documented spinal cord bleeding with coronavirus disease 2019 (COVID-19) infection [12][13][14][15], and we found only one other report of sSDH associated with COVID-19 [16]. We describe a unique case of testicular pain caused by sSDH which is one of the first cases of sSDH associated with an otherwise asymptomatic COVID-19 infection.…”

“…Interestingly, a few recent cases have demonstrated spontaneous spinal hemorrhage, including epidural and intramedullary hematomas with concomitant COVID-19 infection [ 12 - 15 ]. Only one case report discussing spontaneous sSDH with concurrent COVID-19 infection was found in our search [ 16 ]. That case described a 71-year-old female presenting with gait instability, thoracic pain, and left leg weakness associated with acute sSDH involving spinal levels C7-T3.…”

A Zebra Diagnosis: A Case of Spontaneous Hematomyelia Associated With COVID-19

“…She was found to have a spinal subdural hematoma. She had some recovery of her leg weakness after the laminectomy [ 8 ].…”

“…Elevated D-Dimer was associated with both thromboses and bleeding in this study, while disseminated intravascular coagulopathy, clinically relevant thrombocytopenia, and reduced fibrinogen were rare and were associated with bleeding complications [ 11 ]. Blood-brain barrier and endothelial injury secondary to hypoxia and inflammatory response might cause microbleeds and eventually brain and spinal cord hemorrhage, particularly in the presence of anticoagulation use [ 7 , 8 , 11 ]. The association of COVID-19 with hematomyelia in the current literature cannot prove causation.…”

Acute spontaneous subdural hematoma: A literature review

“…Mais uma evidência desse padrão foi obtida pelos relatos deMartínez et al (2022) eDlaka et al (2022). O primeiro trabalho apresenta um homem de 83 anos que foi infectado pelo SARS-CoV-2, desenvolvendo o quadro de COVID-19.…”