Spontaneous Spinal Subdural Hematoma of Intracranial Origin
Spontaneous Spinal Subdural Hematoma of Intracranial Origin
Background Spinal subdural hematoma (SDH) is an uncommon condition mainly associated with bleeding dyscrasias, use of anticoagulants, trauma, iatrogenic procedures, and vascular malformations. Prompt diagnosis and treatment are recommended to prevent progressive neurologic compromise. Spinal SDH concomitant with intracranial SDH is an even rarer entity, with few cases reported in the English literature. Here we present a case of spontaneous spinal SDH with intracranial SDH presenting as sacral back pain in a 70-year-old man. We also describe the potential mechanism, treatment, and prognosis of concomitant spinal and intracranial SDH.
Case Report We report an unusual case of spontaneous spinal SDH concomitant with intracranial SDH and discuss the epidemiology, clinical presentation, potential etiology, treatment, and prognosis of this disease.
Why Should an Emergency Physician Be Aware of This? Awareness of the association between spinal SDH and intracranial SDH can expedite appropriate imaging of both brain and spine, which can lead to a more complete diagnosis and require changes in patient management in the emergency setting.
Spinal hematomas are rare, but the acute progression of spinal hemorrhage can lead to devastating neurologic sequelae. Therefore, prompt identification and treatment is essential. Spinal subdural hematomas (SDHs) account for < 4.1% of all spinal hematomas and are mainly associated with bleeding dyscrasias, use of anticoagulants, trauma, iatrogenic procedures, and vascular malformations. Most present as acute to subacute pain at the level of the spinal hemorrhage and can have neurologic symptoms, including sensory disturbance, progressive weakness, urine and stool retention or incontinence, and paralysis. To our knowledge spinal SDH concomitant with intracranial SDH is even rarer, with cases more commonly a result of trauma and less commonly due to coagulopathy or without any identifiable cause. Here we present an unusual case of spontaneous spinal SDH concomitant with intracranial SDH followed by a discussion on the epidemiology, clinical presentation, potential etiology, treatment, and prognosis of this disease.
Abstract and Introduction
Abstract
Background Spinal subdural hematoma (SDH) is an uncommon condition mainly associated with bleeding dyscrasias, use of anticoagulants, trauma, iatrogenic procedures, and vascular malformations. Prompt diagnosis and treatment are recommended to prevent progressive neurologic compromise. Spinal SDH concomitant with intracranial SDH is an even rarer entity, with few cases reported in the English literature. Here we present a case of spontaneous spinal SDH with intracranial SDH presenting as sacral back pain in a 70-year-old man. We also describe the potential mechanism, treatment, and prognosis of concomitant spinal and intracranial SDH.
Case Report We report an unusual case of spontaneous spinal SDH concomitant with intracranial SDH and discuss the epidemiology, clinical presentation, potential etiology, treatment, and prognosis of this disease.
Why Should an Emergency Physician Be Aware of This? Awareness of the association between spinal SDH and intracranial SDH can expedite appropriate imaging of both brain and spine, which can lead to a more complete diagnosis and require changes in patient management in the emergency setting.
Introduction
Spinal hematomas are rare, but the acute progression of spinal hemorrhage can lead to devastating neurologic sequelae. Therefore, prompt identification and treatment is essential. Spinal subdural hematomas (SDHs) account for < 4.1% of all spinal hematomas and are mainly associated with bleeding dyscrasias, use of anticoagulants, trauma, iatrogenic procedures, and vascular malformations. Most present as acute to subacute pain at the level of the spinal hemorrhage and can have neurologic symptoms, including sensory disturbance, progressive weakness, urine and stool retention or incontinence, and paralysis. To our knowledge spinal SDH concomitant with intracranial SDH is even rarer, with cases more commonly a result of trauma and less commonly due to coagulopathy or without any identifiable cause. Here we present an unusual case of spontaneous spinal SDH concomitant with intracranial SDH followed by a discussion on the epidemiology, clinical presentation, potential etiology, treatment, and prognosis of this disease.
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