Acute spinal subdural hematoma A case report of spontaneous recovery from paraplegia

Medicine, 2020 · DOI: http://dx.doi.org/10.1097/MD.0000000000020032 · Published: May 8, 2020

Neurology Spinal Disorders Research Methodology & Design

Simple Explanation

A spinal subdural hematoma (SSDH) is a rare condition where blood collects between the spinal cord and the dura, potentially causing neurological issues. This report discusses a case where a patient with SSDH experienced spontaneous recovery from paraplegia. The patient, a 59-year-old male, experienced sudden back pain and paraplegia. After conservative treatment including bed rest and rehabilitation, the patient recovered completely. MRI scans revealed that the hematoma decreased in size within a few days, which correlated with the patient's neurological improvement. This suggests that conservative treatment could be considered for SSDH cases showing signs of spontaneous recovery.

Study Duration

Not specified

Participants

A 59-year-old male

Evidence Level

Level 4, Case Report

Key Findings

1
Chronological MRI scans depicted a spontaneous decrease in the hematoma only two days after the presentation of paraplegia.
2
One-week of bed rest and intensive rehabilitation allowed the patient with SSDH to recover motor function completely from paraplegia.
3
The presence of sacral sparing, slight motor recovery after onset, and disappearance of back pain were key factors in determining conservative therapy for SSDH.

Research Summary

This case report describes a 59-year-old male who presented with sudden back pain and paraplegia due to a spontaneous spinal subdural hematoma (SSDH). The patient was treated conservatively with bed rest and intensive rehabilitation, leading to complete recovery. Serial MRI scans documented the resolution of the hematoma and corresponding neurological improvement. The authors suggest that conservative treatment may be a viable option for SSDH patients, particularly those showing early signs of spontaneous recovery, and that close monitoring with MRI is crucial.

Practical Implications

Conservative Treatment Option

Conservative management, including bed rest and rehabilitation, can be a viable treatment option for SSDH, especially when signs of spontaneous recovery are observed.

Importance of MRI Monitoring

Serial MRI scans are crucial for monitoring the resolution process of the hematoma and assessing the patient's neurological status, informing treatment decisions.

Predictive Factors for Conservative Therapy Success

Factors such as sacral sparing, early motor recovery, and resolution of back pain may indicate a higher likelihood of successful conservative treatment.

Study Limitations

1
The etiology of SSDH in this case remains unknown.
2
Angiography and delayed MRI were not performed to exclude vascular malformation.
3
The facility had limitations in equipment and radiological staff, limiting imaging options.

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