Spontaneous spinal subdural haematoma during general anaesthesia

Area of Science:

• Neurosurgery
• Neurology
• Vascular Surgery

Background:

• Spontaneous spinal subdural hematoma (SSDH) is a recognized neurological emergency.
• SSDH typically presents with acute spinal cord compression, often requiring urgent surgical decompression.
• In elderly patients, SSDH is commonly linked to minor trauma or vascular risk factors like hypertension.

Observation:

• A patient developed paraplegia during general anesthesia for ureteral calculus removal.
• Initial assessments did not identify the cause of the neurological deficit.
• Surgical exploration revealed a spinal subdural hematoma as the source of compression.

Findings:

• The underlying cause of the subdural hematoma was determined to be a ruptured spinal vascular malformation.
• The diagnosis of spinal subdural hematoma was delayed until surgical intervention.
• The patient's paraplegia was attributed to the undiagnosed spinal subdural hematoma.

Implications:

• This case underscores the importance of considering rare etiologies for acute neurological deficits, even during unrelated procedures.
• Delayed diagnosis of spinal subdural hematoma can lead to poorer outcomes.
• Prompt surgical exploration is crucial for managing spinal cord compression due to hematoma, regardless of the underlying cause.