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Primary central nervous system vasculitis presenting as spinal subdural hematoma.
Michael Fu1, Sacit Bulent Omay, John Morgan
1Yale University School of Medicine, Department of Neurosurgery, Yale-New Haven Hospital, New Haven, Connecticut, USA. michael.fu@yale.edu
World Neurosurgery
|November 29, 2011
Summary
Primary central nervous system vasculitis (PCNSV) can manifest as spinal subdural hematomas. This rare presentation of PCNSV highlights the need to consider spinal cord vasculitis in differential diagnoses.
Area of Science:
- Neurology
- Vascular Inflammation
- Neuroimmunology
Background:
- Primary central nervous system vasculitis (PCNSV) is a rare inflammatory condition affecting the brain and spinal cord.
- Typical PCNSV symptoms include headache and cognitive changes, but spinal cord involvement is uncommon.
- The causes of spinal cord vasculitis remain largely unknown.
Observation:
- A 69-year-old woman experienced sudden severe back pain and paraplegia after a hypertensive event.
- Magnetic resonance imaging revealed multiple spinal subdural hematomas, necessitating emergency surgical evacuation.
- Intraoperative findings and imaging indicated vasculitic abnormalities confined to the central nervous system.
Findings:
- This case represents the first reported instance of spinal subdural hematomas as the initial presentation of PCNSV.
- The patient's condition was diagnosed as spinal cord vasculitis within the spectrum of PCNSV.
- Vasculitic abnormalities were localized exclusively to the central nervous system.
Implications:
- Spinal subdural hematomas, when nontraumatic, may indicate underlying spinal cord vasculitis.
- PCNSV should be considered in the differential diagnosis for patients presenting with spinal subdural hematomas.
- This finding expands the known clinical spectrum of PCNSV and its spinal manifestations.
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