Traumatic spinal subdural hematoma: An illustrative case and series review

Porter, Zachary R.; Johnson, Mark D.; Horn, Paul S.; Ngwenya, Laura B.

doi:10.1016/j.inat.2019.100570

Cited by 7 publications

(9 citation statements)

References 53 publications

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“…We suspect that the source of the bleeding was intracranial in this case and that blood migrated to the lumbar region rather than there being two distinct sites of bleeding. Our conclusions are consistent with prior research on concurrent intracranial and spinal SDH [ 3 , 5 ] and supported by the high prevalence of intracranial SDH in elderly individuals after falls [ 1 ]. There was also no acute intrinsic lumbar spine pathology evident on MRI (i.e., fracture) that would otherwise explain the patient’s gait abnormality or the lumbar SDH.…”

Section: Discussionsupporting

confidence: 92%

“…There was also no acute intrinsic lumbar spine pathology evident on MRI (i.e., fracture) that would otherwise explain the patient’s gait abnormality or the lumbar SDH. Finally, the patient’s low back pain was not severe until six days after the fall, which is consistent with a previous review that reported a symptom delay of 12.5 ± 15.1 days between trauma and the onset of symptoms related to spinal SDH [ 3 ]. Accordingly, we suspect that the patient’s spinal SDH developed progressively after the fall until becoming symptomatic.…”

Section: Discussionsupporting

confidence: 90%

“…In comparison, spinal SDH is rare, making up only 4% of cases of spinal hematoma [ 2 ]. Even more rarely, an intracranial SDH may migrate downward, causing an additional lumbar SDH [ 3 , 4 ], which may lead to a confusing clinical picture with low back and radicular pain without cranial symptoms [ 3 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…In elderly individuals, bridging veins in this space are more susceptible to tearing as age-related brain atrophy allows for greater brain movement and stretching of these veins [ 9 ]. Conversely, the spinal subdural space contains few blood vessels and is less often a source of bleeding [ 3 ]. However, as the intracranial and spinal subdural spaces are continuous with one another, intracranial SDH may redistribute to the lumbar subdural space as a result of gravity [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, as the intracranial and spinal subdural spaces are continuous with one another, intracranial SDH may redistribute to the lumbar subdural space as a result of gravity [ 5 , 6 ]. A recent review in 2020 identified 16 cases of spinal SDH that occurred in relation to intracranial SDH that had migrated inferiorly [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Concurrent Spinal and Intracranial Subdural Hematomas as a Cause of Near-Fatal Low Back Pain in the Chiropractic Office: A Case Report

Chu¹,

Trager²,

Nga³

et al. 2022

Cureus

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In older individuals, minor trauma may cause potentially fatal intracranial subdural hematoma (SDH). Rarely, these patients present with only low back and radicular pain as gravity redistributes the SDH to the lumbar spine.A 69-year-old male presented to a chiropractor with a 10-day history of acute on chronic low back pain, which radiated into his lower extremities bilaterally, involving weakness and difficulty walking, and a ground-level fall onto his elbows 16 days prior. He had visited his primary care provider, orthopedist, and traditional Chinese medicine practitioner, received oral analgesics and three ketorolac injections, and had lumbar radiographs, followed by acupuncture, cupping, and spinal manipulation without lasting relief. Considering the patient's concerning presentation, the chiropractor ordered lumbar magnetic resonance imaging (MRI) on the first visit, revealing findings suggestive of late subacute lumbar SDH, and recommended urgent brain MRI and neurosurgical referral. The patient went to an orthopedic surgeon at a nearby hospital, becoming disoriented upon presentation, prompting admission. Brain MRI confirmed bilateral chronic intracranial SDH, prompting emergency hematoma evacuation via burr hole craniostomy. The patient's gait rapidly improved, and the pain subsided over the following two weeks. This case highlights an older male identified as having spinal SDH by a chiropractor, leading to referral and surgery for concurrent life-threatening intracranial SDH. Clinicians should be aware that spinal SDH may stem from asymptomatic intracranial SDH and should be suspicious of SDH in older individuals after a fall, signs of which warrant emergency referral for MRI and surgical evaluation.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 90%