Acute spontaneous spinal subdural haematoma presenting as paraplegia and complete recovery with non-operative treatment

Abstract

Spontaneous spinal subdural haematoma (SSDH) with no underlying pathology is a very rare condition. Only 20 cases have been previously reported. It can be caused by abnormalities of coagulation, blood dyscrasia, or trauma, underlying neoplasm, and arteriovenous malformation. It occurs most commonly in the thoracic spine and presents with sudden back pain radiating to the arms, legs or trunk, and varying degrees of motor, sensory, and autonomic disturbances. Although the main approach to management is surgical decompression, conservative management is used as well. We report the case of a 57-year-old man who presented with sudden severe low back pain followed by rapid onset of complete paraplegia. Magnetic resonance imaging (MRI) revealed an anterior subdural haematoma from T9 to L1 with cord compression. Corticosteroid treatment was administered. The patient showed substantial clinical improvement after 7 days of bed rest and an intense rehabilitation programme. An MRI scan and a computed tomography angiogram did not reveal any underlying pathology to account for the subdural haematoma.

Figure 1

Sagittal TI and T2 weighted magnetic resonance images 4 h after onset of symptoms, showing a slightly hyperintense longitudinal space occupying lesion extending from T9 to L1 in the anterior spinal canal on a sagittal spin echo T1 weighted image.

Figure 2

On an axial fast T2 weighted image at L1, a hyperintense lesion is shown.

Figure 3

The haematoma is absent in a sagittal T1 weighted image taken 7 days after the onset of symptoms. The canal is clear, and 7 days later the clinical examination was also normal.

Figure 4

An axial image (7 days after treatment) shows no compression on the spinal cord.