ABSTRACT
Acupuncture is generally regarded as a safe procedure and as a popular treatment for patients with musculoskeletal disorders. We report a case of a 47-year-old male patient with late-onset tetraplegia, developed after acupuncture. He had no trauma, medical, and social history relevant to tetraplegia. Right after the acupuncture, he felt discomfort in his right arm. After 6 days, all 4 extremity weakness developed. Whole-spine magnetic resonance imaging revealed the presence of spinal subdural hematoma extending from the C5 vertebra to the coccyx level. Hand coordination dysfunction, neurogenic bladder, and neuropathic pain were other symptoms. After the management, he recovered muscle strength, but incomplete bladder control and neuralgia were sustained. It is important to be aware of the possibilities of severe complications after acupuncture.
Subject(s)
Humans , Male , Middle Aged , Acupuncture , Arm , Coccyx , Extremities , Hand , Hematoma, Subdural, Spinal , Magnetic Resonance Imaging , Muscle Strength , Neuralgia , Quadriplegia , Spine , Urinary Bladder , Urinary Bladder, NeurogenicABSTRACT
This report describes a case of a 62-year-old woman with microscopic polyangiitis (MPA) who developed acute spinal subdural hemorrhage. MPA was confirmed by positive autoantibodies to myeloperoxidase and focal segmental necrotizing and pauci-immune crescentic glomerulonephritis on renal biopsy. She did not recover from paraplegia due to acute spinal subdural hemorrhage, despite decompression operation and aggressive immunosuppression. Although spontaneous spinal hemorrhage in MPA patients is very rare, the prognosis for such patients is poor. Considering the possibility of ongoing vasculitis activity in extra-renal organs, clinicians should be very cautious to attenuate the strength of immunosuppressant drugs, even in patients with chronic or irreversible renal pathology.
Subject(s)
Female , Humans , Middle Aged , Autoantibodies , Biopsy , Decompression , Glomerulonephritis , Hematoma, Subdural , Hematoma, Subdural, Spinal , Hemorrhage , Immunosuppression Therapy , Microscopic Polyangiitis , Paraplegia , Pathology , Peroxidase , Prognosis , VasculitisABSTRACT
STUDY DESIGN: Retrospective case–control study PURPOSE: To clarify the prevalence and risk factors for spinal subdural lesions (SSDLs) following lumbar spine surgery. OVERVIEW OF LITERATURE: Because SSDLs, including arachnoid cyst and subdural hematoma, that develop following spinal surgery are seldom symptomatic and require reoperation, there are few reports on these pathologies. No study has addressed the prevalence and risk factors for SSDLs following lumbar spine surgery. METHODS: We conducted a retrospective analysis of the magnetic resonance (MR) images and medical records of 410 patients who underwent lumbar decompression surgery with or without instrumented fusion for degenerative disorders. SSDLs were classified into three grades: grade 0, no obvious lesion; grade 1, cystic lesion; and grade 2, lesions other than a cyst. Grading was based on the examination of preoperative and postoperative MR images. The prevalence of SSDLs per grade was calculated and risk factors were evaluated using multivariate logistic regression analysis. RESULTS: Postoperative SSDLs were identified in 123 patients (30.0%), with 50 (12.2%) and 73 (17.8%) patients being classified with grade 1 and 2 SSDLs, respectively. Among these, one patient was symptomatic, requiring hematoma evacuation because of the development of incomplete paraplegia. Bilateral partial laminectomy was a significantly independent risk factor for SSDLs (odds ratio, 1.52; 95% confidence interval, 1.20–1.92; p<0.001). In contrast, a unilateral partial laminectomy was a protective factor (odds ratio, 0.11; 95% confidence interval, 0.03–0.46; p=0.002). CONCLUSIONS: The prevalence rate of grade 1 SSDLs was 30%, with no associated clinical symptoms observed in all but one patient. Bilateral partial laminectomy increases the risk for SSDLs, whereas unilateral partial laminectomy is a protective factor.
Subject(s)
Humans , Arachnoid , Arachnoid Cysts , Decompression , Hematoma , Hematoma, Subdural , Hematoma, Subdural, Spinal , Laminectomy , Logistic Models , Medical Records , Paraplegia , Pathology , Prevalence , Protective Factors , Reoperation , Retrospective Studies , Risk Factors , SpineABSTRACT
We report a healthy patient with postpartum headache and neck stiffness which were diagnosed as symptoms of pseudoaneurysm of vertebral artery. She had received a Cesarean section under the spinal anesthesia, and complaint of headache and neck stiffness. Epidural blood patches were done twice, but symptoms persisted. Eight days later, she experienced sensory disturbance and emergent laminectomy was done. When persistent postpartum headache occurs after epidural blood patch, more precise differential diagnosis should be made and considering other possible pathologies.
Subject(s)
Female , Humans , Pregnancy , Anesthesia, Spinal , Aneurysm, False , Blood Patch, Epidural , Cesarean Section , Diagnosis, Differential , Headache , Hematoma, Subdural, Spinal , Laminectomy , Neck , Pathology , Post-Dural Puncture Headache , Postpartum Period , Vertebral ArteryABSTRACT
Spontaneous spinal subdural hematoma is reported at a rare level of incidence, and is frequently associated with underlying coagulopathy or those receiving anticoagulant or antiplatelet agents; some cases accompany concomitant intracranial hemorrhage. The spontaneous development of spinal subdural hemorrhage (SDH) is a neurological emergency; therefore, early diagnosis, the discontinuation of anticoagulant, and urgent surgical decompression are required to enable neurological recovery. In this report, we present a simultaneous spinal subdural hematoma and cranial subarachnoid hemorrhage, which mimicked an aneurysmal origin in a female patient who had been taking warfarin due to aortic valve replacement surgery.
Subject(s)
Female , Humans , Aneurysm , Aortic Valve , Decompression, Surgical , Early Diagnosis , Emergencies , Hematoma, Subdural , Hematoma, Subdural, Spinal , Incidence , Intracranial Hemorrhages , Platelet Aggregation Inhibitors , Subarachnoid Hemorrhage , WarfarinABSTRACT
Spontaneous spinal subdural hematoma (SDH) is very rare. Furthermore, intracranial vasospasm (ICVS) associated with spinal hemorrhage has been very rarely reported. We present an ICVS case without intracranial hemorrhage following SDH. A 41-year-old woman was admitted to our hospital with a complaint of severe headache. Multiple intracranial vasospasms were noted on a brain CT angiogram and transfemoral cerebral angiography. However, intracranial hemorrhage was not revealed by brain MRI or CT. On day 3 after admission, weakness of both legs and urinary incontinence developed. Spine MRI showed C7~T6 spinal cord compression due to hyperacute stage of SDH. After hematoma evacuation, her symptoms gradually improved. We suggest that spinal cord evaluation should be considered in patients with headache who have ICVS, although intracranial hemorrhage would not be visible in brain images.
Subject(s)
Adult , Female , Humans , Brain , Cerebral Angiography , Headache , Hematoma , Hematoma, Subdural, Spinal , Hemorrhage , Intracranial Hemorrhages , Leg , Magnetic Resonance Imaging , Spinal Cord , Spinal Cord Compression , Spine , Subarachnoid Hemorrhage , Urinary Incontinence , Vasospasm, IntracranialABSTRACT
Spontaneous spinal subdural hematoma (SSDH) is a very rare condition. We report a case of SSDH presenting with Brown-Sequard syndrome, treated by surgical evacuation. A 77-year-old woman was hospitalized for back pain without trauma history. As she showed progressive sensory loss and right-side dominant paraparesis, we performed magnetic resonance imaging and confirmed the SSDH in the thoracic area. Therefore, she underwent emergent operation and the hematoma was evacuated successfully. After the operation, the patient showed improvement in neurologic function.
Subject(s)
Aged , Female , Humans , Back Pain , Brown-Sequard Syndrome , Hematoma , Hematoma, Subdural, Spinal , Magnetic Resonance Imaging , Myelodysplastic Syndromes , Paraparesis , Spinal Cord Injuries , ThrombocytopeniaABSTRACT
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
Un paciente varón de 88 años, en diálisis por insuficiencia renal crónica, presentó cervicalgia intensa y, progresivamente, déficit sensitivo motor completo dependiente de ventilación mecánica. La tomografía cervicodorsal y la resonancia magnética (RM) inicial sugirieron varios diagnósticos, entre ellos hematoma subdural espinal. El tiempo de protrombina y el INR estaban ligeramente fuera del rango normal y las plaquetas eran normales. La RM contrastada hecha al cuarto día indicaba la probable presencia de un hematoma espinal. Se realizó una punción lumbar, la que confirmó in hematoma subdural espinal en fase crónica. Se evacuó 60 mL, sin obtener mejora clínica neurológica. No fue posible realizar una RM de control, debido a la condición clínica del paciente. El paciente falleció debido a una sepsis de foco respiratorio.
A 88yearold male receiving hemodialysis for chronic renal insufficiency, developed cervical pain and progressively motor/sensitive deficit with mechanic ventilation support. Computed tomography and Magnetic resonance imaging (MRI) admission showed a variety of diagnostics, inclunding spinal subdural hematoma. Prothrombin time and international normalized ratio (INR) were slightly out of range, with normal platelets amount. MRI after four days found a spinal subdural hematoma, confirmed with lumbar puncture. Sixty cc was evacuated without neurologic amelioration. A new MRI was impossible to perform. He died due a respiratory sepsis.
Subject(s)
Humans , Male , Aged, 80 and over , Hematoma, Subdural, Spinal , Spinal PunctureABSTRACT
Spinal subdural hematoma is a rarely reported disease and spontaneous spinal subdural hematomas (SSDH) without underlying pathological changes are even rarer. The patients usually show typical symtoms such as back pain, quadriplegia, paraplegia or sensory change. But rarely, patients may show atypical symptoms such as hemiparesis and misdiagnosed to cerebrovascular accident. We recently experienced a case of SSDH, where the patient initially showed vague symptoms, such as the sudden onset of headache which we initially misdiagnosed as subarachnoid hemorrhage. In this case, the headache of patient improved but the neck pain persisted until hospital day 5. Therefre, we conducted the MRI of cervical spine and finally confirmed SSDH. The patient was managed conservatively and improved without recurrence. In this case report, we discuss the clinical features of SSDH with emphasis on the importance of an early diagnosis.
Subject(s)
Humans , Back Pain , Diagnosis , Early Diagnosis , Headache , Hematoma, Subdural, Spinal , Magnetic Resonance Imaging , Neck Pain , Paraplegia , Paresis , Quadriplegia , Recurrence , Spine , Stroke , Subarachnoid HemorrhageABSTRACT
Spinal subdural hematoma is a rarely reported disease and spontaneous spinal subdural hematomas (SSDH) without underlying pathological changes are even rarer. The patients usually show typical symtoms such as back pain, quadriplegia, paraplegia or sensory change. But rarely, patients may show atypical symptoms such as hemiparesis and misdiagnosed to cerebrovascular accident. We recently experienced a case of SSDH, where the patient initially showed vague symptoms, such as the sudden onset of headache which we initially misdiagnosed as subarachnoid hemorrhage. In this case, the headache of patient improved but the neck pain persisted until hospital day 5. Therefre, we conducted the MRI of cervical spine and finally confirmed SSDH. The patient was managed conservatively and improved without recurrence. In this case report, we discuss the clinical features of SSDH with emphasis on the importance of an early diagnosis.
Subject(s)
Humans , Back Pain , Diagnosis , Early Diagnosis , Headache , Hematoma, Subdural, Spinal , Magnetic Resonance Imaging , Neck Pain , Paraplegia , Paresis , Quadriplegia , Recurrence , Spine , Stroke , Subarachnoid HemorrhageABSTRACT
Although blood contamination of cerebrospinal fluid (CSF) after an intracranial operation can occur, the development of a symptomatic spinal hematoma after craniotomy has been anecdotally reported and it is uncommon reported after a supratentorial meningioma removal operation. We report a case of spinal subdural hematoma following a supratentorial meningioma removal operation and discuss the mechanism of spinal subdural hematoma (SSDH) development. A 54-year-old woman presented with lumbago and radicular pain on both legs 4 days after a right parietooccipital craniotomy for meningioma removal. Only the straight leg raising sign was positive on neurologic examination but the magnetic resonance imaging (MRI) demonstrated a lumbosacral spinal subdural hematoma. The patient received serial lumbar tapping, after which her symptoms showed improvement.
Subject(s)
Female , Humans , Middle Aged , Cerebrospinal Fluid , Craniotomy , Hematoma , Hematoma, Subdural, Spinal , Leg , Low Back Pain , Magnetic Resonance Imaging , Meningioma , Neurologic ExaminationABSTRACT
Traumatic lumbosacral spinal subdural hematoma due to anatomical and pathological causes is rare, compared to epidural hematoma. If the time of trauma cannot be determined, intracranial and intraspinal signal intensity according to lapse of time are not coincident, resulting in confusion in terms of differentiation. Fat suppression magnetic resonance image (MRI) and computed tomography (CT) are utilized for differentiation. The intention of this study is to report on a case where spinal subdural hematoma of unknown time of occurrence is differentiated from subdural lipoma by taking advantage of fat suppression MRI and CT in order to perform an early surgical decompression with auxiliary review of literature demonstrating good prognosis of the procedure.
Subject(s)
Decompression, Surgical , Hematoma , Hematoma, Subdural, Spinal , Intention , Lipoma , Magnetics , Magnets , PrognosisABSTRACT
Coexistence of cranial and spinal subdural hematomas is rare and only a few cases have been reported in the literature. Herein, we report a case of cranial and spinal subdural hematomas after previous head trauma. As the pathogenesis of simultaneous intracranial and spinal subdural hematoma yet remains unclear, we developed an alternative theory to those proposed in the literature for their coexistence, the migration of blood through the subdural space.
Subject(s)
Craniocerebral Trauma , Hematoma, Subdural , Hematoma, Subdural, Spinal , Subdural SpaceABSTRACT
Lumbar puncture is a simple bedside procedure that is essential for the diagnosis and treatment of several neurologic diseases. Known complications include headache, backache, infection, and hemorrhage, with the most common being postpuncture headache. We report a case of postpuncture spinal subdural hematoma-which is extremely rare-in a 29-year-old female. Although most cases of postpuncture spinal hematomas are associated with coagulation abnormalities, this case shows that it can occur in the absence of predisposing factors.
Subject(s)
Female , Humans , Back Pain , Headache , Hematoma , Hematoma, Subdural, Spinal , Hemorrhage , Spinal PunctureABSTRACT
A 39-year old female presented with chronic spinal subdural hematoma manifesting as low back pain and radiating pain from both legs. Magnetic resonance imaging (MRI) showed spinal subdural hematoma (SDH) extending from L4 to S2 leading to severe central spinal canal stenosis. One day after admission, she complained of nausea and severe headache. Computed tomography of the brain revealed chronic SDH associated with midline shift. Intracranial chronic SDH was evacuated through two burr holes. Back pain and radiating leg pain derived from the spinal SDH diminished about 2 weeks after admission and spinal SDH was completely resolved on MRI obtained 3 months after onset. Physicians should be aware of such a condition and check the possibility of concurrent cranial SDH in patients with spinal SDH, especially with non-traumatic origin.
Subject(s)
Female , Humans , Back Pain , Brain , Constriction, Pathologic , Headache , Hematoma, Subdural , Hematoma, Subdural, Spinal , Leg , Low Back Pain , Magnetic Resonance Imaging , Nausea , Spinal CanalABSTRACT
Los hematomas espinales no traumáticos son condiciones clínicas infrecuentes dentro de la literatura médica, sin embargo se han descrito varios casos comprometiendo los diversos compartimientos a nivel medular e inclusive secundario a migración de hematomas de origen intracraneal. Con este artículo se pretende revisar esta patología como urgencia neuroquirúrgica con el principal propósito de dar a conocer en la práctica médica las manifestaciones clínicas y posibles factores relacionados. Se da una idea de la importancia del tratamiento quirúrgico temprano y del pronóstico neurológico..
Nontraumatic spinal hematomas are infrequent clinical conditions in medical literature. However, there are some reported cases of hematomas affecting all the medular compartments and, even, secondary to a cranial hematoma migration. With this article we aim to review this pathology as a neurosurgical urgency with the main purpose of let know in the clinical practice, the clinical manifestations signs and symptoms, and posible factors that can be related to its etiology. We give an idea of the importance of early surgical treatment and neurological prognosis..
Subject(s)
Diagnosis , Hematoma, Epidural, Spinal , Hematoma, Subdural, Spinal , PrognosisABSTRACT
Reports of spontaneous spinal chronic subdural hematoma (SDH) are extremely rare. In the limited cases reported, the origin, symptoms and treatments are diversely revealed. Therefore accurate diagnoses and proper treatments are difficult to determine. We report a 74-year-old male presented with severe low back pain and both buttocks pain. Magnetic resonance imaging showed a diffuse subdural infiltrating mass compress nerve roots at the level of L2-S2. Emergency operation for decompression and excision of mass revealed spinal chronic SDH. His pain was subsided after the operation. We report a rare case of idiopathic lumbosacral spinal chronic SDH and discuss various causes and treatments.
Subject(s)
Aged , Humans , Male , Buttocks , Decompression , Emergencies , Hematoma, Subdural, Chronic , Hematoma, Subdural, Spinal , Low Back Pain , Magnetic Resonance Imaging , Spinal Cord CompressionABSTRACT
Reports of spontaneous spinal chronic subdural hematoma (SDH) are extremely rare. In the limited cases reported, the origin, symptoms and treatments are diversely revealed. Therefore accurate diagnoses and proper treatments are difficult to determine. We report a 74-year-old male presented with severe low back pain and both buttocks pain. Magnetic resonance imaging showed a diffuse subdural infiltrating mass compress nerve roots at the level of L2-S2. Emergency operation for decompression and excision of mass revealed spinal chronic SDH. His pain was subsided after the operation. We report a rare case of idiopathic lumbosacral spinal chronic SDH and discuss various causes and treatments.
Subject(s)
Aged , Humans , Male , Buttocks , Decompression , Emergencies , Hematoma, Subdural, Chronic , Hematoma, Subdural, Spinal , Low Back Pain , Magnetic Resonance Imaging , Spinal Cord CompressionABSTRACT
We report herein a case of hyperacute onset of spontaneous cervical spinal subdural hematoma treated with methylprednisolone pulse therapy that showed good results. A 57-year-old man was admitted for posterior neck pain and paraparesis which occurred an hour ago. MRI revealed a ventral subdural hematoma distributed from the level of C1 down to T3, compressing the spinal cord. Conservative management with methylprednisolone pulse therapy was administered considering the patient's poor general condition. Although emergent surgical decompression is necessary in most cases of spinal subdural hematoma, conservative management with steroid therapy could be effective.