Simultaneous Nontraumatic Spinal and Intracranial Subdural Hematoma.

Nontraumatic subdural hematoma (SDH) of the spine following intracranial SDH is extremely rare (1). The patient was 67-year-old woman receiving anticoagulant therapy following mitral valve replacement who developed sudden onset headache. She had no history of evident trauma. Her international normalized ratio of prothrombin time (PT-INR) was 3.10. Fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) of the brain showed a thin SDH (Picture A). She was treated conservatively and the target PT-INR range was 2.0-2.5. On the 11th day of hospitalization, Brain MRI revealed that the SDH had increased in size (Picture B). She also complained of radiating pain in her left leg. Both T1-weighted and T2-weighted images of the spine showed areas of high signal intensity extending from the C7 level to the S2 level in the spinal subdural space (arrows in Picture C and D). Axial MRI at the L5 level showed an inverted Mercedes Benz sign (arrows in Picture E) (2).

Picture.

The authors state that they have no Conflict of Interest (COI).