Do cranial subdural hematomas migrate to the lumbar spine?
We report a patient with minor head trauma-related bilateral hemispheric subdural hematoma (SDH) and subsequent delayed spinal SDH or presumed migration to the lumbar spine. An acutely confused 88-year-old man presented to the Emergency Department after minor head trauma. Head CT scan revealed a small hemispheric SDH. The patient was admitted for observation. CT scan 6 hours later showed bilateral SDH with extension to the tentorium. Three days later SDH had resolved leaving bilateral subdural hygromas. Local leg weakness localized to the lumbar spine developed on day 6; spinal CT scan and MRI revealed a posterior L5-S1 collection. A pure subacute subdural hematoma compressing the cauda equina was drained after an L5 laminectomy. His lower leg weakness improved. The patient was discharged to rehabilitation two weeks after surgery. Patients with traumatic SDH who develop late-onset neurological deterioration attributable to any region of the spine should be evaluated for spinal SDH.
Department of Neurosurgery, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel.
S
S
Moscovici
I
I
Paldor
F
F
Ramirez de-Noriega
E
E
Itshayek
Y
Y
Shoshan
S
S
Spektor
M
M
Attia
D000369:Aged, 80 and over; D006259:Craniocerebral Trauma / Q000150:complications; D004322:Drainage; D046648:Hematoma, Subdural, Intracranial / Q000209:etiology / Q000473:pathology*; D046649:Hematoma, Subdural, Spinal / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008161:Lumbosacral Region / Q000473:pathology*; D008297:Male; D017202:Myocardial Ischemia / Q000150:complications; D013353:Subdural Effusion / Q000209:etiology / Q000473:pathology