OBJECTIVE AND IMPORTANCE: Spinal subdural hematoma (SSDH) is a rare entity, and cases are usually managed as surgical emergencies. We describe a patient with a SSDH who demonstrated incomplete clinical resolution with nonsurgical management, despite continued anticoagulation treatment. We provide the most complete demonstration of the magnetic resonance imaging (MRI) characteristics of a large SSDH from its initiation to its radiological resolution. CLINICAL PRESENTATION: A 61-year-old woman developed a large SSDH as a complication of a lumbar puncture. Her only neurological deficit was urinary retention. INTERVENTION: Because of the extensiveness of the hematoma and the relative neurological preservation of the patient, she was treated conservatively. Serial MRI scans were obtained at 4, 7, 13, and 25 days. The evolution of deoxyhemoglobin in the hematoma to methemoglobin was observed. By 25 days, MRI scans showed virtual resolution. CONCLUSION: SSDHs undergo MRI signal changes that are similar to those of brain hematomas. In certain cases, even large SSDHs demonstrate swift and dramatic spontaneous resolution, despite continued anticoagulation treatment. This report suggests that there is a role for conservative management for selected cases of SSDHs.
OBJECTIVE AND IMPORTANCE: Spinal subdural hematoma (SSDH) is a rare entity, and cases are usually managed as surgical emergencies. We describe a patient with a SSDH who demonstrated incomplete clinical resolution with nonsurgical management, despite continued anticoagulation treatment. We provide the most complete demonstration of the magnetic resonance imaging (MRI) characteristics of a large SSDH from its initiation to its radiological resolution. CLINICAL PRESENTATION: A 61-year-old woman developed a large SSDH as a complication of a lumbar puncture. Her only neurological deficit was urinary retention. INTERVENTION: Because of the extensiveness of the hematoma and the relative neurological preservation of the patient, she was treated conservatively. Serial MRI scans were obtained at 4, 7, 13, and 25 days. The evolution of deoxyhemoglobin in the hematoma to methemoglobin was observed. By 25 days, MRI scans showed virtual resolution. CONCLUSION: SSDHs undergo MRI signal changes that are similar to those of brain hematomas. In certain cases, even large SSDHs demonstrate swift and dramatic spontaneous resolution, despite continued anticoagulation treatment. This report suggests that there is a role for conservative management for selected cases of SSDHs.
Authors: Mehmet Teksam; Sean O Casey; Alexander McKinney; Eduard Michel; Charles L Truwit Journal: Neuroradiology Date: 2003-07-16 Impact factor: 2.804