ISSN: 2041-6792

Clinical Investigation

Spinal Subdural Hematoma

 Spinal subdural hematoma (SDH) is a rare and potentially lifethreatening condition associated with trauma, lumbar puncture, hemorrhagic disorder, anticoagulant therapy, spinal surgery,tumor, vascular malformations, and spinal or epidural anesthesia. Traumatic spinal SDH is more uncommon with only 10 reportedcases in the literature. This case report involves alumbosacral SDH following a head injury. A 35-year-old man presented for neurosurgical consultation1week after being punched in the head and losing consciousness.An initial brain computed tomography (CT) was negative for any bonydefects or intracranial hemorrhage. On presentation, the patientreported headaches, right-sided tinnitus, and a dull ache behind botheyes. He also reported sacral pain that radiated into his buttocks andwas exacerbated by movement. Motor examination revealed 5/5motor strength throughout the lower extremities, positive straight leg-raise test at 30° bilaterally, positive bowstring test bilaterally, andpositive femoral stretch test bilaterally. A lumbar spine magnetic resonance image (MRI) without contrastdemonstrated an isolated lumbar SDH extending from L4 to S1causing mild spinal stenosis . At a follow-up visit 2days afterthe initial presentation, the patient reported continuing right-sidedtinnitus and bilateral sacral radiculopathy when rising or lying downand with upward and lateral gaze. The patient was treatedconservatively with 20mg oral prednisone once daily for 10days,with planned 1-month follow-up and repeat MRI of the lumbar spine.Blood tests including liver function tests, coagulation studies, andcomplete blood count were all within normal limits.  

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