Department of Neurosurgery, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan.
Department of Neurosurgery, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan.
World Neurosurg. 2019 Jul;127:275-278. doi: 10.1016/j.wneu.2019.04.063. Epub 2019 Apr 13.
Spontaneous spinal subdural hematoma (SDH) is rare but leads to severe nerve compression. According to the symptoms, surgery decompression and conservative treatment are justified options. We present a spontaneous spinal SDH case treated by decompression surgery for the lumbar region and conservative observation for the thoracic region. A series of images of the disease course is available.
A 55-year-old woman without malignancy or coagulopathy history presented with progressive low back pain for the past 2 weeks. Progressive bilateral leg weakness happened 1 week ago. On the day she called for help, she presented with bilateral leg grade 2 muscle power and generalized back pain. There was no headache or meningeal sign. An absent bilateral knee reflex was found. Magnetic resonance imaging showed a space-occupying lesion at the T2-T6 and T12-L1 levels in the ventral and dorsal spinal canal, leading to cord compression. Due to rapid neurologic function deterioration, emergent T12-L1 laminectomy was performed. We found a T12-L1 tense dura sac with subdural hematoma ventral to the cord. Removal of the SDH was performed. T2-T6 levels were treated conservatively. She returned ambulant 1 week after operation. Magnetic resonance images at 3 months and 1 year later showed the SDH being absorbed and replaced by adhesive arachnoid cysts along the whole T and L spine. However, these lesions are asymptomatic for at least 2 years.
Surgical intervention is recommended in patients presenting with severe neurologic deficits. Conservative treatment is a reasonable option for asymptomatic patients.
自发性脊柱硬脊膜下血肿（SDH）较为罕见，但可导致严重的神经压迫。根据症状，手术减压和保守治疗都是合理的选择。我们报告了一例自发性脊柱 SDH 病例，患者接受了腰椎减压手术，而胸椎则采用保守观察治疗。提供了一系列疾病过程的图像。
一名 55 岁女性，无恶性肿瘤或凝血功能障碍病史，过去 2 周出现进行性腰痛。1 周前出现双侧下肢无力。在她呼救的当天，她出现双侧下肢肌力 2 级和全身背痛。无头痛或脑膜刺激征。双侧膝反射消失。磁共振成像显示 T2-T6 和 T12-L1 水平的脊髓腹侧和背侧椎管内占位性病变，导致脊髓受压。由于神经功能迅速恶化，紧急进行了 T12-L1 椎板切除术。我们发现 T12-L1 紧张硬脊膜囊有硬脊膜下血肿位于脊髓腹侧。行 SDH 清除术。T2-T6 水平采用保守治疗。术后 1 周她可以步行出院。术后 3 个月和 1 年后的磁共振图像显示 SDH 被吸收，并沿整个 T 和 L 脊柱被黏连性蛛网膜囊肿取代。然而，这些病变至少 2 年无症状。
对于出现严重神经功能缺损的患者，建议进行手术干预。对于无症状患者，保守治疗是合理的选择。
