RESUMEN
RATIONALE: Spontaneous spinal subdural hematoma (SSDH) is a rare disease that can cause severe permanent neurological dysfunction. Here we present a case of spontaneous SSDH, in which a series of magnetic resonance images (MRIs) taken through the course of the disease facilitated understanding of the resolution process of the hematoma and the diagnosis of SSDH. PATIENT CONCERNS: A 59-year-old male presented with sudden severe back pain and rapid onset of paraplegia. This symptom had continued developing while he was transferred to the emergency department. Initial physical examination showed flaccid paralysis of both lower limbs with areflexia and loss of all sensation below T6 bilaterally. MRI images showed an anterior subdural hematoma from C7 to T7 with spinal cord compression. DIAGNOSIS: Based on MRI findings, the diagnosis was SSDH. INTERVENTIONS: We chose conservative treatment of 1-week bed rest and intensive rehabilitation for the patient due to the presence of sacral sparing and the slight motor recovery at 24âhours after the onset. OUTCOMES: Frequent MRI images demonstrated that the spinal cord compression was surprisingly mitigated only 2 days and mostly absorbed 4 days after the onset. The patient's motor function was recovered completely and he was discharged after 8 weeks of hospitalization. LESSONS: Our chronological MRI findings provide crucial information for diagnosing SSDH and also suggest that spinal surgeons should consider the potential option of a conservative approach for treating SSDH. Although prompt selection of a therapeutic strategy for SSDH could be challenging, the surgeons could observe the course of the patient's neurological status for a few days to detect signs of spontaneous recovery.
Asunto(s)
Tratamiento Conservador/métodos , Hematoma Subdural Espinal , Imagen por Resonancia Magnética/métodos , Paraplejía , Canal Medular/diagnóstico por imagen , Hematoma Subdural Espinal/complicaciones , Hematoma Subdural Espinal/diagnóstico , Hematoma Subdural Espinal/fisiopatología , Hematoma Subdural Espinal/rehabilitación , Humanos , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico/métodos , Examen Neurológico/métodos , Paraplejía/etiología , Paraplejía/fisiopatología , Paraplejía/rehabilitación , Recuperación de la Función , Remisión Espontánea , Resultado del TratamientoRESUMEN
A 68-year-old man on apixaban presented to the emergency department with back pain following a long-haul flight. Investigations for pulmonary embolus and aortic dissection were negative and he was discharged with analgesia for mechanical back pain. He presented three more times with worsening back pain, third time with urinary retention and the fourth time with lower limb weakness and loss of coordination. He was found to have a spinal subdural haematoma on MRI and transferred to a tertiary centre, where he was managed conservatively and discharged for rehabilitation with good neurological recovery.
Asunto(s)
Dolor de Espalda/etiología , Hematoma Subdural Espinal/inducido químicamente , Hematoma Subdural Espinal/diagnóstico por imagen , Pirazoles/efectos adversos , Piridonas/efectos adversos , Anciano , Ataxia/etiología , Dolor de Espalda/diagnóstico , Tratamiento Conservador , Diagnóstico Diferencial , Inhibidores del Factor Xa/efectos adversos , Hematoma Subdural Espinal/rehabilitación , Humanos , Enfermedad Iatrogénica/epidemiología , Imagen por Resonancia Magnética/métodos , Masculino , Resultado del Tratamiento , Retención Urinaria/etiologíaRESUMEN
Spinal subdural hematoma (SSDH) is a rare entity and post-traumatic cervical SSDH is very rare. Review of the literature revealed 8 reported cases of traumatic SSDH and only 2 were cervical. The exact mechanism and pathogenesis of SSDHs are unclear. There are still controversies about the source of bleeding and mechanisms of formation of a hematoma. Here we report a case of a unique traumatic craniocervical junction focal subdural hematoma in an 8-year-old boy and discuss the possible mechanisms of SSDHs in trauma cases.
