Kyriakides Athanasios E, Lalam Radesh K, El Masry Wagih S
Midlands Centre for Spinal Injuries, Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, UK.
Spine (Phila Pa 1976). 2007 Oct 1;32(21):E619-22. doi: 10.1097/BRS.0b013e318154c618.
Case report.
To report an unusual case of spontaneous spinal subdural hematoma and to review relevant literature and discuss the etiology, pathogenesis, clinical features, imaging, and prognosis.
Spontaneous spinal subdural hematoma with no underline pathology is a very rare condition. Only 19 cases have been previously reported.
The case of a 44-year-old man is presented. Pubmed (Medline) was used to search publications.
Our patient presented with sudden severe low back pain following a minimal effort, with rapid onset of complete paraplegia. MRI revealed an anterior subdural hematoma from T2-T6 with cord compression. An urgent laminectomy was performed. MRI scan, surgery, and CT angiogram did not reveal any underlying pathology to account for the subdural hematoma. The patient demonstrated substantial clinical improvement after 6 weeks of bed rest and intense rehabilitation program.
Spinal subdural hematoma (SSDH) is uncommon and can be caused by abnormalities of coagulation, blood dyscrasias, or trauma, underlying neoplasm, and arteriovenous malformation. SSDH is very rare in the absence of these underlying conditions. It occurs most commonly in the thoracic spine and presents with sudden back pain radiating to the arms, legs or trunk, varying degrees of motor, sensory, and autonomic disturbances. On MRI, SSDH is seen as a space-occupying lesion, usually ventrally, contained within the dura matter, and can demonstrate variable T1 and T2 signal depending on the age of the hematoma. The prognosis is variable. The majority of cases in the literature had surgical decompression, although cases that were managed conservatively have been reported to be successful as well. The indications of surgery need to be clarified.
病例报告。
报告一例罕见的自发性脊髓硬膜下血肿病例，并回顾相关文献，探讨其病因、发病机制、临床特征、影像学表现及预后。
无潜在病理改变的自发性脊髓硬膜下血肿是一种非常罕见的疾病。此前仅报道过19例。
介绍一名44岁男性患者的病例。使用PubMed（医学文献数据库）检索相关出版物。
我们的患者在轻微用力后突然出现严重的下背部疼痛，并迅速发展为完全性截瘫。MRI显示T2至T6水平的硬膜下前血肿伴脊髓受压。紧急进行了椎板切除术。MRI扫描、手术及CT血管造影均未发现导致硬膜下血肿的任何潜在病理改变。经过6周的卧床休息和强化康复治疗后，患者的临床症状有了显著改善。
脊髓硬膜下血肿（SSDH）并不常见，可由凝血异常、血液系统疾病、创伤、潜在肿瘤及动静脉畸形引起。在没有这些潜在疾病的情况下，SSDH非常罕见。它最常发生于胸椎，表现为突发背痛并向手臂、腿部或躯干放射，伴有不同程度的运动、感觉及自主神经功能障碍。在MRI上，SSDH表现为占位性病变，通常位于硬膜内前方，根据血肿的时间其T1和T2信号可有所不同。预后因人而异。文献中的大多数病例接受了手术减压，不过也有报道称保守治疗同样成功。手术指征有待明确。
