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Surgical Management of Concurrent Cranial and Spinal Subdural Hematomas Causing Confusion and Lower-Extremity
Max S Fleisher1, Christina La Gamma1, Michael K Rosner1
1Department of Neurosurgery, George Washington University Hospital, Washington, DC, USA.
Insights
Simultaneous cranial and spinal subdural hematomas (CSDH and SSDH) are rare but require prompt surgical intervention. This case demonstrates the safety and feasibility of tandem surgery for concurrent CSDH and SSDH.
Area of Science:
- Neurosurgery
- Neurology
- Radiology
Background:
- Simultaneous cranial (CSDH) and spinal subdural hematomas (SSDH) are infrequent clinical occurrences.
- Optimal management strategies for concurrent CSDH and SSDH are debated, with proposed etiologies including dual insult or craniocaudal migration.
Purpose of the Study:
- To report a case of concurrent CSDH and SSDH in a 40-year-old male.
- To demonstrate the safety and feasibility of tandem surgical intervention for concomitant CSDH and SSDH.
Main Methods:
- A 40-year-old male presented with progressive low back pain, radiculopathy, and weakness.
- Imaging confirmed concurrent chronic CSDH and SSDH.
- The patient underwent craniotomy and multilevel laminectomy with intradural exploration for hematoma evacuation within 72 hours.
Main Results:
- The patient presented with confusion and lower-extremity weakness.
- Surgical intervention was performed after initial refusal and subsequent presentation following a fall.
- The patient was admitted to the intensive care unit post-operatively.
Conclusions:
- Concurrent CSDH and SSDH are rare but clinically significant, often requiring intervention.
- Early and aggressive surgical management of both lesions is feasible and safe when indicated.
- This case highlights the successful outcome of tandem surgical intervention for simultaneous CSDH and SSDH.
Abstract:
BACKGROUND Simultaneous cranial and spinal subdural hematomas are rare. When cranial (CSDH) and spinal subdural hematomas (SSDH) are identified concurrently, optimal management depends on hematoma size, chronicity, degree of compression or shift, and the patient's neurologic status. Proposed etiologies include dual insult versus craniocaudal migration. Here, we report the case of a 40-year-old man presenting with confusion and lower-extremity weakness due to concurrent intracranial and spinal subdural hematomas. This report aims to demonstrate the safety and feasibility of tandem surgical intervention for concomitant CSDH and SSDH. CASE REPORT A 40-year-old man presented with 1 week of progressive low back pain, bilateral radiculopathy, weakness, and urinary symptoms. Imaging revealed concurrent chronic cranial and spinal SDH. At initial evaluation, the patient was agitated and combative, unable to grasp the scope of his clinical situation; he declined surgical intervention and left the hospital. He returned the following day after a ground-level fall. After further counseling, he underwent craniotomy and multilevel laminectomy with intradural exploration for evacuation of both hemorrhages within 72 h of initial presentation and admission to the intensive care unit. CONCLUSIONS Concurrent cranial and spinal subdural hematomas are rare but clinically significant, and both lesions may be symptomatic and require intervention. Acute surgical management of simultaneously diagnosed CSDH and SSDH is infrequently reported, with most cases attributed to either dual insult or craniocaudal migration. This case report demonstrates the safety and feasibility of early, relatively aggressive surgical intervention when both lesions meet the criteria for urgent evacuation.
