Surgery complicationsSpinal subdural hematoma: a sequela of a ruptured intracranial aneurysm?
Section snippets
Case report
A 52-year-old woman presented with left oculomotor nerve palsy and subarachnoid hemorrhage (SAH) because of the rupture of a left internal carotid artery aneurysm. Preoperative computed tomography (CT) showed SAH predominantly in the prepontine cistern and subdural hematoma beneath the cerebellar tentorium. However, SAH was not prominent in the supratentorial region, such as the basal cistern or Sylvian fissures (Figure 1). The patient underwent left temporo-parietal craniotomy and clipping of
The location of the spinal hematoma
We considered that the exact location of the spinal hematoma in our case was not the subarachnoid space but the subdural extra-arachnoid space for the following reasons: (1) Axial T2-weighted MR images showed that the hematoma was located between the high signal intensity of the triangle-shaped epidural fat tissue and the CSF [1]; (2) it took more than a month for the hematoma to diminish completely. If the hematoma were located in the subarachnoid space, the diminution would be more rapid.
The pathogenesis of SSDH
Conclusion
Spinal subdural hematoma is rare. However, it must be considered a possible sequela of a ruptured intracranial aneurysm when the patient shows neurologic symptoms related to the spinal cord or roots. When intracranial subdural hematoma is present in the pre- and postoperative CT images, intrathecal thrombolytic therapy should be performed with great care.
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Spinal Subdural Hematoma owing to the Removal of Cerebrospinal Fluid Drainage Tube During Thoracic Endovascular Aortic Repair
2020, World NeurosurgeryCitation Excerpt :However, there were no findings suggestive of spinal SAH on spinal MRI. Previous reports of spinal SDH caused by intracranial SAH suggested that they resulted from hematoma migration from the intracranial space due to direct sedimentation or CSF hypotension.23,24 Graffeo et al.6 reported a case of intracranial SAH and spinal cord SDH, which was thought to be caused by CSF hypotension after laminectomy for spinal stenosis.
Aneurysmal Subarachnoid Hemorrhage with Spinal Subdural Hematoma: A Case Report and Systematic Review of the Literature
2019, World NeurosurgeryCitation Excerpt :To better understand cases of spontaneous S-SDH in the setting of aneurysmal SAH, we conducted a systematic review of the literature. We examined trends in clinical presentation, patient characteristics, management, and clinical outcomes.1,9-16 In addition, we report a new case to illustrate an improvement in neurologic outcome after surgical intervention.
Lumbosacral Subdural Hematoma and Concomitant Acute Lower Extremity Monoparesis After Intracranial Aneurysmal Subarachnoid Hemorrhage
2016, World NeurosurgeryCitation Excerpt :Kostov et al.7 reported 2 cases of delayed-onset lower extremity monoparesis caused by lumbosacral subarachnoid hematoma after intracranial aneurysmal SAH and proposed that blood products from SAH may irritate local nerve roots preferentially affecting motor efferent roots. Several case reports have described spinal SDH after rupture of intracranial aneurysm (Table 1).2-4,8 Intracranial SDH may be produced directly by rupture of an intracranial aneurysm2,3 or occur after intracranial aneurysm surgery as a result of surgical trauma or CSF overdrainage.3,4