ABSTRACT
Concomitant traumatic spinal cord and intracranial subdural hematomas associated with a retroclival hematoma are very uncommon. Their pathophysiology is not totally elucidated, but one hypothesis is the migration of the hematoma from the head to the spine. In the present case report, the authors describe the case of a 51-year-old man presenting with headache, nauseas and back pain after a head trauma who presented with intracranial and spinal cord subdural hematomas. Drainage was performed but, 1 week later, a retroclival subdural hematoma was diagnosed. The present paper discusses the pathophysiology, the clinical presentation, as well as the complications of concomitant traumatic spinal cord and intracranial subdural hematomas associated with a retroclival hematoma, and reviews this condition.
Subject(s)
Humans , Male , Middle Aged , Hematoma, Subdural, Intracranial/surgery , Hematoma, Subdural, Intracranial/complications , Hematoma, Subdural, Intracranial/physiopathology , Hematoma, Epidural, Spinal/surgery , Hematoma, Subdural, Spinal/complications , Hematoma, Subdural, Spinal/physiopathology , Brain Injuries, TraumaticABSTRACT
A 57-year-old man complained of severe lower back pain and radicular pain in both legs for 1 week after falling from a ladder. Magnetic resonance imaging (MRI) of the spine showed a subdural hematoma (SDH), which was surgically removed. The patient had no back pain or the radicular leg pain at 2 weeks post-surgery. However, he complained of diffuse headaches upon follow-up. Brain computed tomography (CT) and MRI revealed an intracranial SDH, which was immediately removed by surgery. During his 1-year follow-up, he reported that the pain had resolved without recurrence. Simultaneous spinal and intracranial SDH are rare and no standard treatment exists for this condition. This case suggests that it is possible that an intracranial SDH can migrate into the cerebrospinal fluid (CSF) space through an arachnoid tear. CSF circulation allows the intracranial SDH to enter subarachnoid spaces encasing the spinal cord. In order to prevent irreversible damage, surgical intervention should be considered for case of spinal SDH with progressive neurological deficits.
Subject(s)
Humans , Middle Aged , Arachnoid , Back Pain , Brain , Cerebrospinal Fluid , Follow-Up Studies , Headache , Hematoma, Subdural , Hematoma, Subdural, Intracranial , Hematoma, Subdural, Spinal , Leg , Low Back Pain , Magnetic Resonance Imaging , Recurrence , Spinal Cord , Spinal Injuries , Spine , Subarachnoid Space , Subdural Space , TearsABSTRACT
The spinal subdural hematoma (SSDH) is a rare disease entity, but may have disastrous consequences. A 48-year-old man who underwent a craniotomy for a removal of acute traumatic subdural hematoma was referred to our hospital because of remnant hematoma and sustained headache. His mental state was clear and the score of Glasgow Coma Scale was 15. On 11days after admission, he complained of lumbago and radicular pain in the lower extremities. Lumbar magnetic resonance image (MRI) revealed subacute lumbosacral subdural hamatoma. A lumbar puncture was performed and about 20cc amount of dark liquefied hematoma was drained. His symptoms were improved and the SSDH was disappeared on follow-up MRI. This SSDH is assumed to be formed by the migratory movement of intracranial subdural hematoma under the influence of gravity, and spinal puncture is another preferable procedure in such cases of liquefied spinal hematoma.