Traumatic spinal subdural hematoma [Neurosurgery Wiki]

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====== Traumatic spinal subdural hematoma ======

===== Etiopathogenesis =====

The [[etiopathogenesis]] of traumatic [[spinal subdural hematoma]] (SSH) is uncertain. Unlike the [[supratentorial]] [[subdural]] space, no [[bridging vein]]s traverse the spinal subdural space. 

===== Diagnosis =====

[[Spinal subdural hematoma diagnosis]].


===== Case reports =====
A 56 year old man presented with progressive left lower limb [[radiculopathy]] and [[paresthesia]]s with [[claudication]] of three days duration. MRI revealed a subdural space occupying lesion compressing the [[cauda equina]] at L5-S1 level producing a 'Y' shaped dural sac (Y sign), which was hyperintense on T1W imaging and hypointense to cord on T2W image. The STIR sequence showed hyperintensity to cord. There was no history of bleeding diathesis. The patient underwent decompressive durotomy and biopsy which confirmed the diagnosis.

Spinal subdural hematoma may present with rapidly progressive neurological symptoms. MRI is the investigation of choice. The knowledge of MRI appearance with respect to the chronological stage of the bleed is essential to avoid diagnostic and hence surgical dilemma
((Manish K K, Chandrakant SK, Abhay M N. Spinal Subdural Haematoma. J Orthop
Case Rep. 2015 Apr-Jun;5(2):72-4. doi: 10.13107/jocr.2250-0685.280. PubMed PMID: 
27299051; PubMed Central PMCID: PMC4722598.
)).
----
First case reported after violent back massage. Maste et al. emphasized a high index of suspicion for early recognition and treatment for a good neurological recovery.

A 41-year-old male was brought to our hospital with severe back pain, motor and sensory impairments of the bilateral lower extremities, and urinary dysfunction after vigorous back massage. Magnetic resonance images revealed an acute spinal subdural hematoma in the thoracolumbar region. After careful monitoring of his neurological status, the patient was successfully managed with conservative treatment.

After 2 weeks of hospitalization, complete motor power recovery was achieved with only minor sensory deficit. At a follow-up of more than 12 months, the patient has no residual neurological deficits.

Spinal subdural hematoma secondary to physical trauma is quite rare. This case brings new information that traumatic spinal subdural hematoma can be caused by violent massage
((Maste P, Paik SH, Oh JK, Kim YC, Park MS, Kim TH, Kwak YH, Jung JK, Lee HW,
Kim SW. Acute spinal subdural hematoma after vigorous back massage: a case report
and review of literature. Spine (Phila Pa 1976). 2014 Dec 1;39(25):E1545-8. doi: 
10.1097/BRS.0000000000000629. PubMed PMID: 25271505.
)).
----
Bortolotti et al. described a case of subacute SSH that occurred after spontaneous resolution of traumatic [[intracranial subdural hematoma]] and suggest a causal relationship between the two. A 23-year-old woman suffered an acute [[intracranial]] SDH after a snowboarding accident. There was no clinical or radiological evidence of [[spine injury]]. [[Conservative]] management of the supratentorial SDH resulted in spontaneous radiologically documented resolution with redistribution of blood in the subdural space. Four days after the injury, the patient started noticing new onset of mild [[low back pain]]. The pain progressively worsened. [[Magnetic resonance imaging of the lumbar spine]] 10 days after the original injury revealed a large L4-S2 SDH. Ten days after the original injury, bilateral L5-S1 [[laminotomy]] and [[drainage]] of the [[subacute]] spinal SDH were performed. The patient experienced immediate pain relief. The authors hypothesize that in some cases spinal SDH may be related to redistribution of blood from the supratentorial subdural space
((Bortolotti C, Wang H, Fraser K, Lanzino G. Subacute spinal subdural hematoma
after spontaneous resolution of cranial subdural hematoma: causal relationship or
coincidence? Case report. J Neurosurg. 2004 Apr;100(4 Suppl Spine):372-4. PubMed 
PMID: 15070147.
)).

===== References =====