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Acute nontraumatic spinal subdural hematomas in three patients
X Morandi1, L Riffaud, E Chabert
1Departments of Neurosurgery and Neuroradiology, Pontchaillou Hospital, University of Rennes, Rennes, France. xavier.morandi@chu-rennes.fr
Spine
|November 29, 2001
Summary
Spinal subdural hematomas are a rare complication of anticoagulant therapy. Prompt surgical evacuation and magnetic resonance imaging are crucial for diagnosis and managing these hematomas.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Spinal subdural hematomas (SSDHs) are rare intraspinal hematomas.
- Anticoagulant therapy is a potential risk factor for SSDH.
- Few cases of SSDH have detailed magnetic resonance (MR) findings.
Observation:
- Three patients on anticoagulant therapy presented with acute, nontraumatic SSDH.
- All patients had complete preoperative neurologic deficits.
- Surgical evacuation was performed within 26 hours of symptom onset.
Findings:
- Sagittal T1- and T2-weighted MR imaging effectively delineated the hematoma.
- Intraoperative findings revealed hematomas confined to the dura-arachnoid or extending into the subarachnoid space.
- Postoperative recovery was limited, with incomplete improvement in two patients.
Implications:
- SSDH should be considered in patients on anticoagulants with acute spinal cord compression symptoms.
- MR imaging is a reliable diagnostic tool for SSDH.
- Preoperative neurologic deficit severity is critical for functional outcome despite timely surgical intervention.