Spontaneous Spinal Subdural Hematoma Concurrent with Cranial Subdural Hematoma
A 39-year-old female presented with about a 10-days history of low back pain and pain radiating from both legs. She was transferred to our department under the diagnosis of spinal SDH. The patient had no history of antecedent head or back injuries, but had intermittent pulsatile headache for 2 weeks. Laboratory examinations eliminated the possibility of coagulopathy-related diseases. Neurologic examination showed no definite motor weakness and sensory change. Spinal MRI showed a diffuse mass encircling the thecal sac, leading to moderate to severe central spinal stenosis at the L4 to S2 vertebral levels. Axial MRI revealed that the hematoma was located between the epidural fat and cerebrospinal fluid space, indicating localization in the subdural space ().\nThe patient was treated conservatively because the pain was not severe. She refused surgery. One day after admission, the pre-existing headache (which had not been a complaint in the outpatient clinic) became aggravated, and nausea and vomiting developed. Computed tomography of the brain revealed a chronic cranial SDH associated with midline shift in the left hemisphere (). The cranial SDH was evacuated, which prevented brain herniation if lumbar decompression was necessary. Postoperatively, the headache gradually resolved (). We scheduled another evacuation of spinal SDH to be performed if neurologic deficit developed. However, low back pain and pain radiating from both legs gradually improved. Three months later, a lumbar MRI showed complete resolution of the spinal SDH ().