Predictors of Outcome in Nontraumatic Spontaneous Acute Spinal Subdural Hematoma: Case Report and Literature Review.

OBJECTIVES: To analyze the clinical presentation and outcome of nontraumatic spontaneous acute spinal subdural hematoma by observing the predictors of outcome. METHODS/RESULTS: This study was based on a case report and systematic review of the international literature. Among the 151 patients, 80 were female and 65 were male (1.25 female/1.0 male). The age distribution ranged from 6 months to 87 years, with a small increase in incidence between the first and second decade of life and a major peak at age 60 years. The difference of proportion of good results between patients with and without established neurologic deficits was: 0.488, 95% confidence interval (95% CI) 0.237-0.648, P = 2.71e-08; coagulopathy was 0.335, 95% CI 0.163-0.508, P = 0.0002; SAH was 0.0539, 95% CI -0.119 to 0.226, P = 0.6529; lumbar puncture/associated diseases was 0.149 95% CI -0.032 to 0.330, P = 0.1171; surgery was 0.0593, 95% CI -0.114 to 0.233, P = 0.5838; and hematoma extension equal or longer than 5 levels was 0.010 95% CI -0.178 to 0.197, P = 1. CONCLUSIONS: Although mortality and morbidity associated with nontraumatic spontaneous acute spinal subdural hematoma has decreased during the last 2 decades, the disease still carries a mortality rate of approximately1.3% and a morbidity (permanent neurologic deficits) rate of 28%. The main factors affecting the outcome are neurologic status at presentation and coagulopathies.

Intracranial aneurysm arising from infundibular dilation.

Infundibular dilations (IDs) are funnel-shaped enlargements in the origin of intracranial arteries. Usually, IDs occur at the junction between posterior communicating artery (PcomA) and internal carotid artery (ICA). Progression from an ID of the PcomA to aneurysms has been described, but is unclear whether an ID is a preaneurysmal state or a normal anatomical variant. The authors describe a 55-year-old female patient presenting multiple intracranial aneurysms with a small one arising from an ID at the level of posterior communicating segment of ICA. To the best of our knowledge, after a criterious search in the English literature, it is the first description of such unusual combination. The preoperative neurosurgical planning is discussed as well as the importance of intraoperative findings to the best management of this unusual situation.