Limardo Abner A, Berrios José J, Pagán Adrián, de Jesús Reynaldo, Espinet Rafael
Graduate Medical Education, Centro Médico Episcopal San Lucas, Ponce, PRI.
Internal Medicine, Centro Médico Episcopal San Lucas, Ponce, PRI.
Cureus. 2024 Sep 30;16(9):e70525. doi: 10.7759/cureus.70525. eCollection 2024 Sep.
A spontaneous spinal subdural hematoma (SSSH) is a rare but potentially deadly condition characterized by the presence of blood in the subdural space, commonly causing compression of the spinal cord and acute neurological deficits. Urgent surgical intervention with a decompressive laminectomy is warranted to avoid lasting deficits. The literature on this pathology is scarce, and the etiology is still poorly understood, although associations have been established with arteriovenous malformations, rupture of epidural vessels, and anticoagulant use, among others. This study presents the case of an 81-year-old Hispanic woman with a past medical history including an unspecified arrhythmia on treatment with oral anticoagulation who presented to the emergency room with sudden-onset, localized low back pain and an acute neurological deficit consisting of bilateral lower extremity paraplegia and areflexia. Magnetic resonance imaging (MRI) of the thoracic spine shows a 10-cm-long subdural hematoma causing compression from T5 to T10. At this time, the patient also developed an unstable atrial fibrillation with rapid ventricular response. After cardiac stabilization, a thoracic decompressive laminectomy with hematoma evacuation was performed. The degree of preoperative neural deficit and time to surgical intervention are prognostic factors for clinical recovery in these patients. Anticoagulant medication use is a risk factor for SSSH, and a high index of suspicion is needed for patients presenting with acute-onset back pain and neurological deficits, especially in the setting of known risk factors. MRI is the diagnostic tool of choice, and urgent surgical decompression is warranted to prevent further neurologic deterioration.
自发性脊髓硬膜下血肿（SSSH）是一种罕见但可能致命的疾病，其特征是硬膜下间隙有血液存在，通常会导致脊髓受压和急性神经功能缺损。紧急进行减压性椎板切除术的手术干预是必要的，以避免持久的功能缺损。关于这种病理学的文献很少，病因仍知之甚少，尽管已确定其与动静脉畸形、硬膜外血管破裂和使用抗凝剂等有关。本研究报告了一例81岁的西班牙裔女性病例，其既往病史包括口服抗凝治疗的不明心律失常，该患者因突发局部腰痛和急性神经功能缺损（包括双下肢截瘫和反射消失）就诊于急诊室。胸椎磁共振成像（MRI）显示一个10厘米长的硬膜下血肿，从T5至T10造成压迫。此时，患者还出现了伴有快速心室反应的不稳定型心房颤动。在心脏功能稳定后，进行了胸椎减压性椎板切除术并清除血肿。术前神经功能缺损的程度和手术干预的时间是这些患者临床恢复的预后因素。使用抗凝药物是SSSH的一个危险因素，对于出现急性背痛和神经功能缺损的患者，尤其是在已知危险因素的情况下，需要高度怀疑。MRI是首选的诊断工具，紧急手术减压对于防止进一步的神经功能恶化是必要的。
