Spinal Subarachnoid Hematoma as a Complication of an Intramuscular Stimulation : Case Report and a Review of Literatures
A 45-year-old man was hospitalized at a local clinic because of back pain. On the last day at the clinic, the patient underwent an IMS procedure and subsequently experienced severe headache and nausea. The patient underwent conservative management of the symptoms, but symptoms persisted. The patient was then referred to our hospital. Upon arrival, the patient had stable vital signs. A review of his medical history revealed a 5-year use of antihypertensive drugs, including daily aspirin (100 mg). Physical examination revealed neck stiffness without any other initial neurologic deficits. Clinical laboratory findings were all normal. Brain computed tomography (CT) was performed because the patient was suspected of having intracranial subarachnoid hemorrhage. But, this showed no abnormal findings. Because the patient continued to experience severe headache and nausea, he was admitted to the neurosurgical department for further evaluation and treatment. On the following day, the patient experienced severe back pain, decreased motor power of the lower extremities and constant headache. Based on these findings, the patient was suspected having intraspinal subarachnoid hematoma. The patient was interviewed in detail about the IMS procedure and its relatedness to the onset of headache. The patient stated that he had a history of severe radiating pain toward the lower extremities, while the IMS was directed toward the back. The severe headache and nausea occurred following the IMS procedure. We performed magnetic resonance imaging (MRI) of the thoracolumbar spine. But, the radiologic findings were suggestive of intraspinal subarachnoid hematoma (). The patient underwent an emergency exploratory laminectomy expecting to find a intradural hematoma. Then, we observed a solid hematoma compressing the cauda equina in the operative field (). The hematoma was completely evacuated. No evidence of tumor or vascular malformation was evident on histopathologic examination. Postoperatively, the patient's symptoms gradually improved. On postoperative week 3, the patient was discharged without any complications.