Spontaneous Spinal Subdural Hematoma

Background: 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. Case Description: 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. Conclusions: Surgical intervention is recommended in patients presenting with severe neurologic deficits. Conservative treatment is a reasonable option for asymptomatic patients.