ABSTRACT
OBJECTIVE: Spinal subdural hematomas (SSDHs) are rare. Causes are (1) posttraumatic, (2) iatrogenic (following surgery or lumbar puncture), (3) spontaneous including underlying malformations or coagulation deficits. With a systematic review of literature we want to shed light on the last group: symptomatology, etiology, treatment and outcome will we discussed. METHODS: Systematic review of literature on PubMed for cases of acute nontraumatic noniatrogenic SSDHs in adults (≥18 y of age). A total of 122 cases were reviewed including 2 cases from our hospital. RESULTS: There was a slight preponderance of female patients with spontaneous SSDHs and the mean age was 60 years. Spontaneous SSDHs were mostly located in the thoracic region (40%). Motor symptoms were most frequent (89%), followed by pain. Sensory deficits were present in 64%, of which 81% had a sensory level. In 6% radiculating pain, without any focal neurological deficits, was the presenting symptom. SSDHs were mainly caused by a coagulopathy (48%), predominantly due to the use of coumarins (34%). Other causes were underlying (vascular) malformations and vasculitis. Forty-three percent the SSDHs was idiopathic. 72% of patients underwent a decompressive laminectomy. 59% had a favorable outcome and 34% had a poor outcome. CONCLUSIONS: Spontaneous SSDHs were predominantly located in the thoracic spine, presenting with paraparesis/paraplegia, sensory level and pain. Over 40% was caused by a coagulation defect, most frequently due to coumarins. Six percent of patients presented with radiculating pain without any focal neurological deficits.
Subject(s)
Hematoma, Subdural, Spinal , Adolescent , Adult , Aged , Aged, 80 and over , Female , Hematoma, Subdural, Spinal/etiology , Hematoma, Subdural, Spinal/pathology , Hematoma, Subdural, Spinal/physiopathology , Humans , Male , Middle Aged , Young AdultABSTRACT
Balance disorders in the elderly often have several contributing causes. The search for these causes focuses on vision, proprioception, coordination and medication. The peripheral vestibular system is often overlooked. This is probably due to the fact that most clinicians overlook the vestibular system, when complaints of vertigo are missing. However, dysfunction of the vestibular system may cause imbalance without vertigo. Three cases are presented. One case illustrates several contributing causes leading to imbalance. Two other cases illustrate causes of vestibular dysfunction resulting in imbalance without vertigo: a bilateral vestibulopathy and benign paroxysmal positional vertigo. Symptoms, examination and treatment are discussed. All patients with imbalance should undergo a Head Impulse Test and Dix-Hallpike maneuver.
