Nontraumatic spinal subdural haematoma occurring in a postpartum period

Spontaneous occurrence of spinal subdural haematoma (SSH) is very rare. While many neurological disorders can develop in pregnant patients in relation to haemostatic imbalance, there have been no reports in the literature suggesting that pregnancy and/or childbirth per se could be a single risk factor for acute SSH.A 38-year-old previously healthy woman gave birth to a baby via transvaginal normal delivery. The patient had no history of receiving anticoagulants. Eight days after delivery, she experienced sudden onset severe interscapular back pain, and the next day she developed dysesthesia in the both legs and mild urinary retention. Severe meningeal signs were noted. Lumbar puncture revealed bloody cerebrospinal fluid. Magnetic resonance images revealed SSH in the ventral position spreading from levels Th1 to Th7. The patient underwent conservative treatment after which the symptoms gradually improved. Serial MRI study at 17 and 69 days after onset showed spontaneous regression of the SSH. Spinal angiography did not show any vascular malformations, but simultaneous cerebral angiography revealed a co-existing cerebral aneurysm on the C2 segment of the left internal carotid artery. It is unlikely that the cerebral aneurysm was the origin of the SSH, based on the clinical and radiographic findings. Moreover, we confirmed the unruptured nature of the aneurysm during the clipping procedure at open surgery. We report the unique case of subacute SSH occurring 8 days after childbirth without other known risk factors. The possible etiology and magnetic resonance imaging (MRI) findings in this case, and the current controversy concerning therapy for SSH are discussed.