Traumatic cervical spine subarachnoid hemorrhage with hematoma and cord compression presenting as Brown-Séqüard syndrome: illustrative case

Abstract

BACKGROUND Spinal hematomas are a rare entity with broad etiologies, which stem from idiopathic, tumor-related, and vascular malformation etiologies. Less common causes include traumatic blunt nonpenetrating spinal hematomas with very few cases being reported. In the present manuscript presents a case report and review of the literature of a rare traumatic entity of a cervical subarachnoid hematoma in association with Brown-Séquard syndrome in a patient on anticoagulants. Searches were performed on PubMed and Embase for specific terms related. OBSERVATIONS A well-documented case of an 83-year-old female taking anticoagulants with traumatic cervical subarachnoid hematoma presenting as Brown-Séquard syndrome was reported. Six similar cases were identified, scrutinized, and analyzed in the literature review. LESSONS Traumatic blunt nonpenetrating cervical spine subarachnoid hematomas are a rare entity that can happen more specifically in anticoagulant users and in patients with arthritic changes and stenosis of the spinal canal. Rapid neurological deterioration and severe disability warrant early aggressive surgical treatment. This report has the intention to record this case in the medical literature for registry purposes.

Management of traumatic cervical epidural hematoma in patients on Xa-inhibitors: a case report and review of the literature

“…Patient’s primary risk factors included history of factor X inhibitor anticoagulation and trauma. The literature review suggested that there are independent risk factors for the development of CEH [ 5 ]. One recent phenomenon is the prevalence of using anticoagulants among the aging population for conditions such as atrial fibrillation, cerebrovascular diseases, and coronary artery disease [ 5 ].…”

“…The literature review suggested that there are independent risk factors for the development of CEH [ 5 ]. One recent phenomenon is the prevalence of using anticoagulants among the aging population for conditions such as atrial fibrillation, cerebrovascular diseases, and coronary artery disease [ 5 ]. Disruption of coagulative properties, resulting from iatrogenic and paraneoplastic factors, also constitute increased risks of the development of hematoma or bleeding.…”

“…Absence of anticoagulation in the setting of a spinal epidural hematoma has been noted to be protective, with a 4–5 odds ratio of complete recovery whether surgically or non-operatively treated [ 10 ]. MRI has been recommended as the primary imaging of choice for diagnosis of the CEH, however, in this case, the initial signs of CEH were noted on cervical CT scan without IV contrast which is the most prevalent imaging study available at hospitals [ 3 , 5 ].…”

“…Complications of a CEH may include spinal cord compression and compromised neural tracts responsible for somatosensory and motor function. These symptoms may progress to lasting paresis or even death [ 2 , 5 ]. Though the incidence of cervical spinal cord compression in the setting of CEH has been reported in as low as 2.4%, patients on anticoagulants involved in traumatic injuries are more likely to sustain extensive bleeding resulting in cord compression [ 6 ].…”

“…Initial imaging studies may include computerized tomography (CT) scan or CT angiography which may reveal signs of epidural bleeding or early hematoma formation, however less than 25% of CEH cases are identified on these initial scans. In the setting of new, persistent, or worsening symptoms, CEH is often noted on the subsequent CT or magnetic resonance imaging (MRI) [ 2 , 3 , 5 ]. These studies may not be ordered in the setting of absence of neurological symptoms.…”