Ibrahim Bilal, Al-Khawaldeh Maher, Abu Sirhan Lina A, Arabyat Abdallah, Abdallah Rahmeh A, Hiasat Mohammad Y, Nadi Mustafa, Dabbas Waleed F
Faculty of Medicine, Division of Neurosurgery, Department of Special Surgery, Al-Balqa Applied University, Al-Salt, JOR.
Department of Interventional Neuroradiology, Jordanian Royal Medical Service, Amman, JOR.
Cureus. 2024 Aug 6;16(8):e66283. doi: 10.7759/cureus.66283. eCollection 2024 Aug.
Spinal subdural hematoma (SSDH) is a rare condition where the exact pathology is unclear; coagulopathy, bleeding disorders, trauma, and iatrogenic causes are frequently associated with SSDH. SARS-CoV-2 infection and COVID-19 vaccines are unusual causes of SSDH, as reported by multiple studies. Here, we present a rare case report and a narrative review of SSDH resulting from a ruptured cerebral aneurysm. A 53-year-old female presented with an acute, severe suboccipital headache and neck and back pain without radiculopathy. Investigations for cardiovascular diseases and brain images were unremarkable. Further investigation revealed an SSDH extending from T1 to S2. Negative spinal angiography led to a cerebral angiogram, identifying an internal carotid artery ophthalmic segment aneurysm that was successfully treated with endovascular stent-assisted coiling. This case scenario of anterior circulation cerebral aneurysmal rupture manifesting as an isolated SSDH is unique compared to previously reported cases of SSDH resulting from cerebral aneurysms. This case highlights the importance of considering aneurysmal rupture in SSDH cases with no apparent underlying pathology to prevent neurological deficits. Early detection and intervention in such cases can prevent serious neurological deficits and improve patient outcomes.
脊髓硬膜下血肿（SSDH）是一种罕见病症，其确切病理尚不清楚；凝血病、出血性疾病、创伤和医源性病因常与SSDH相关。多项研究报告称，严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染和新冠病毒疫苗是SSDH的不常见病因。在此，我们报告一例罕见病例，并对脑动脉瘤破裂导致的SSDH进行叙述性综述。一名53岁女性出现急性、严重的枕下头痛以及颈部和背部疼痛，无神经根病。心血管疾病检查和脑部影像均无异常。进一步检查发现SSDH从T1延伸至S2。脊髓血管造影结果为阴性，随后进行了脑血管造影，发现颈内动脉眼段动脉瘤，通过血管内支架辅助弹簧圈栓塞成功治疗。与先前报道的由脑动脉瘤导致的SSDH病例相比，这种前循环脑动脉瘤破裂表现为孤立性SSDH的病例情况较为独特。该病例强调了在无明显潜在病理的SSDH病例中考虑动脉瘤破裂以预防神经功能缺损的重要性所在。在此类病例中早期检测和干预可预防严重神经功能缺损并改善患者预后。
