Sankarappan Kiran, Doucet Dakota, Daly Samuel R, Nguyen Anthony V, Garrett David, Lesley Walter S, Feng Dongxia, Vance Awais Z, Huang Jason H
Neurosurgery, Baylor Scott & White Medical Center, Temple, USA.
Cureus. 2023 Sep 20;15(9):e45627. doi: 10.7759/cureus.45627. eCollection 2023 Sep.
Spinal subarachnoid hemorrhage (SSAH) is a rare condition that can cause spinal cord or nerve root compression and permanent neurologic damage. The reported etiologies include trauma, vascular malformations or aneurysms, coagulopathies, neoplasms, autoimmune disease, and spontaneous hemorrhage. If there is evidence of neurologic deterioration, it is commonly managed as a surgical emergency, but cases of conservative management have also been reported. In this case series, we present three patients who suffered from SSAH. The first was a spontaneous cervical SSAH that occurred following cardiac catheterization, the second was a spontaneous thoracolumbar SSAH in a patient with a known history of coagulopathy, and the third was a thoracolumbar SSAH that was caused by a dural arteriovenous fistula (dAVF). All three patients exhibited neurologic deficits and thus underwent emergent decompression and hematoma evacuation. The patient with the dAVF also required open ligation of the fistula. Following surgical intervention, all three patients regained at least partial neurologic function, but one patient developed symptomatic arachnoid cysts that required further intervention. The presented case series highlights the importance and time-sensitivity of surgical decompression in patients experiencing neurologic deficits from SSAH. These cases underscore the urgency of timely neurosurgical intervention to mitigate neurologic impairment and add insights to the existing literature on this rare condition.
脊髓蛛网膜下腔出血（SSAH）是一种罕见的疾病，可导致脊髓或神经根受压以及永久性神经损伤。报道的病因包括创伤、血管畸形或动脉瘤、凝血功能障碍、肿瘤、自身免疫性疾病和自发性出血。如果有神经功能恶化的证据，通常将其作为外科急症处理，但也有保守治疗的病例报道。在本病例系列中，我们介绍了三名患有SSAH的患者。第一例是心脏导管插入术后发生的自发性颈段SSAH，第二例是一名有已知凝血功能障碍病史患者的自发性胸腰段SSAH，第三例是由硬脊膜动静脉瘘（dAVF）引起的胸腰段SSAH。所有三名患者均出现神经功能缺损，因此接受了紧急减压和血肿清除术。患有dAVF的患者还需要对瘘管进行开放结扎。手术干预后，所有三名患者至少恢复了部分神经功能，但有一名患者出现了有症状的蛛网膜囊肿，需要进一步干预。本病例系列强调了对因SSAH出现神经功能缺损的患者进行手术减压的重要性和时间敏感性。这些病例强调了及时进行神经外科干预以减轻神经损伤的紧迫性，并为关于这种罕见疾病的现有文献增添了见解。
