Acupuncture is generally regarded as a safe procedure and as a popular treatment for patients with musculoskeletal disorders. We report a case of a 47-year-old male patient with late-onset tetraplegia, developed after acupuncture. He had no trauma, medical, and social history relevant to tetraplegia. Right after the acupuncture, he felt discomfort in his right arm. After 6 days, all 4 extremity weakness developed. Whole-spine magnetic resonance imaging revealed the presence of spinal subdural hematoma extending from the C5 vertebra to the coccyx level. Hand coordination dysfunction, neurogenic bladder, and neuropathic pain were other symptoms. After the management, he recovered muscle strength, but incomplete bladder control and neuralgia were sustained. It is important to be aware of the possibilities of severe complications after acupuncture.
Acupuncture ; Arm ; Coccyx ; Extremities ; Hand ; Hematoma, Subdural, Spinal ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Muscle Strength ; Neuralgia ; Quadriplegia ; Spine ; Urinary Bladder ; Urinary Bladder, Neurogenic

Most cases of spinal subdural hematoma are very rare and result from iatrogenic causes, such as coagulopathy or a spinal puncture. Cases of non-traumatic spinal subdural hematoma accompanied by intracranial hemorrhage are even more rare. There are a few reports of spontaneous spinal subdural hematoma with concomitant intracranial subdural or subarachnoid hemorrhage, but not with intracerebral hemorrhage. Especially in our case, the evaluation and diagnosis were delayed because the spontaneous intracerebral hemorrhage accompanying the unilateral spinal subdural and subarachnoid hemorrhages caused hemiplegia. We report a case of spinal subdural and subarachnoid hemorrhage with concomitant intracerebral hemorrhage, for the first time, with a relevant literature review.
Cerebral Hemorrhage ; Diagnosis ; Hematoma ; Hematoma, Subdural, Spinal ; Hemiplegia ; Intracranial Hemorrhages ; Spinal Puncture ; Subarachnoid Hemorrhage

Spinal subdural hematoma (SDH) is rarely reported, and their simultaneous occurrence with intracranial SDH is even more rare. A 67-year-old male patient with a history of posterolateral fusion to treat an L2 burst fracture came to our outpatient clinic due to an inability to walk by himself over the previous 3 weeks. A neurological examination revealed that the patient was alert with occasional confusion and slight motor weakness in the lower extremities. Brain and lumbar spine magnetic resonance imaging (MRI) was then performed. A brain MRI revealed a large subacute SDH along the right cerebral convexity and falx cerebri with midline shifting, and a spine MRI revealed a right side-predominant subacute SDH extending from L4 to S1. For treatment, burr hole trephination of the intracranial SDH and fluoroscopy-guided lumbar puncture of the spinal SDH were performed and resulted in a favorable outcome. This is a report of a rare case of spontaneous intracranial and lumbar spine SDH. We include a review of the current literature and a discussion of the pathogenesis of this condition in this report.
Aged ; Ambulatory Care Facilities ; Brain ; Hematoma, Subdural ; Hematoma, Subdural, Spinal ; Humans ; Lower Extremity ; Magnetic Resonance Imaging ; Male ; Neurologic Examination ; Spinal Cord ; Spinal Puncture ; Spine ; Trephining

This report describes a case of a 62-year-old woman with microscopic polyangiitis (MPA) who developed acute spinal subdural hemorrhage. MPA was confirmed by positive autoantibodies to myeloperoxidase and focal segmental necrotizing and pauci-immune crescentic glomerulonephritis on renal biopsy. She did not recover from paraplegia due to acute spinal subdural hemorrhage, despite decompression operation and aggressive immunosuppression. Although spontaneous spinal hemorrhage in MPA patients is very rare, the prognosis for such patients is poor. Considering the possibility of ongoing vasculitis activity in extra-renal organs, clinicians should be very cautious to attenuate the strength of immunosuppressant drugs, even in patients with chronic or irreversible renal pathology.
Autoantibodies ; Biopsy ; Decompression ; Female ; Glomerulonephritis ; Hematoma, Subdural* ; Hematoma, Subdural, Spinal ; Hemorrhage ; Humans ; Immunosuppression ; Microscopic Polyangiitis* ; Middle Aged ; Paraplegia ; Pathology ; Peroxidase ; Prognosis ; Vasculitis

No abstract available.
Hematoma, Subdural, Spinal ; Humans ; Rivaroxaban

STUDY DESIGN: Retrospective case–control study PURPOSE: To clarify the prevalence and risk factors for spinal subdural lesions (SSDLs) following lumbar spine surgery. OVERVIEW OF LITERATURE: Because SSDLs, including arachnoid cyst and subdural hematoma, that develop following spinal surgery are seldom symptomatic and require reoperation, there are few reports on these pathologies. No study has addressed the prevalence and risk factors for SSDLs following lumbar spine surgery. METHODS: We conducted a retrospective analysis of the magnetic resonance (MR) images and medical records of 410 patients who underwent lumbar decompression surgery with or without instrumented fusion for degenerative disorders. SSDLs were classified into three grades: grade 0, no obvious lesion; grade 1, cystic lesion; and grade 2, lesions other than a cyst. Grading was based on the examination of preoperative and postoperative MR images. The prevalence of SSDLs per grade was calculated and risk factors were evaluated using multivariate logistic regression analysis. RESULTS: Postoperative SSDLs were identified in 123 patients (30.0%), with 50 (12.2%) and 73 (17.8%) patients being classified with grade 1 and 2 SSDLs, respectively. Among these, one patient was symptomatic, requiring hematoma evacuation because of the development of incomplete paraplegia. Bilateral partial laminectomy was a significantly independent risk factor for SSDLs (odds ratio, 1.52; 95% confidence interval, 1.20–1.92; p<0.001). In contrast, a unilateral partial laminectomy was a protective factor (odds ratio, 0.11; 95% confidence interval, 0.03–0.46; p=0.002). CONCLUSIONS: The prevalence rate of grade 1 SSDLs was 30%, with no associated clinical symptoms observed in all but one patient. Bilateral partial laminectomy increases the risk for SSDLs, whereas unilateral partial laminectomy is a protective factor.
Arachnoid ; Arachnoid Cysts ; Decompression ; Hematoma ; Hematoma, Subdural ; Hematoma, Subdural, Spinal ; Humans ; Laminectomy ; Logistic Models ; Medical Records ; Paraplegia ; Pathology ; Prevalence* ; Protective Factors ; Reoperation ; Retrospective Studies ; Risk Factors* ; Spine*

We report a healthy patient with postpartum headache and neck stiffness which were diagnosed as symptoms of pseudoaneurysm of vertebral artery. She had received a Cesarean section under the spinal anesthesia, and complaint of headache and neck stiffness. Epidural blood patches were done twice, but symptoms persisted. Eight days later, she experienced sensory disturbance and emergent laminectomy was done. When persistent postpartum headache occurs after epidural blood patch, more precise differential diagnosis should be made and considering other possible pathologies.
Anesthesia, Spinal ; Aneurysm, False ; Blood Patch, Epidural* ; Cesarean Section ; Diagnosis, Differential ; Female ; Headache ; Hematoma, Subdural, Spinal* ; Humans ; Laminectomy ; Neck ; Pathology ; Post-Dural Puncture Headache ; Postpartum Period* ; Pregnancy ; Vertebral Artery

Rupture of isolated posterior spinal artery (PSA) aneurysms is a rare cause of subarachnoid hemorrhage (SAH) that presents unique diagnostic challenges owing to a nuanced clinical presentation. Here, we report on the diagnosis and management of the first known case of an isolated PSA aneurysm in the context of leukocytoclastic vasculitis. A 53-year-old male presented to an outside institution with acute bilateral lower extremity paralysis 9 days after admission for recurrent cellulitis. Early magnetic resonance imaging was read as negative and repeat imaging 15 days after presentation revealed SAH and a compressive spinal subdural hematoma. Angiography identified a PSA aneurysm at T9, as well as other areas suspicious for inflammatory or post-hemorrhagic reactive changes. The patient underwent a multilevel laminectomy for clot evacuation and aneurysm resection to prevent future hemorrhage and to establish a diagnosis. The postoperative course was complicated by medical issues and led to the diagnosis of leukocytoclastic vasculitis that may have predisposed the patient to aneurysm development. Literature review reveals greater mortality for cervical lesions than thoracolumbar lesions and that the presence of meningitic symptoms portents better functional outcome than symptoms of cord compression. The outcome obtained in this case is consistent with outcomes reported in the literature.
Aneurysm* ; Angiography ; Arteries* ; Cellulitis ; Diagnosis ; Hematoma, Subdural, Spinal ; Hemorrhage ; Humans ; Laminectomy ; Lower Extremity ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Mortality ; Paralysis ; Rupture ; Spinal Cord Vascular Diseases ; Subarachnoid Hemorrhage ; Vasculitis* ; Vasculitis, Leukocytoclastic, Cutaneous

Spontaneous spinal subdural hematoma (SDH) is very rare. Furthermore, intracranial vasospasm (ICVS) associated with spinal hemorrhage has been very rarely reported. We present an ICVS case without intracranial hemorrhage following SDH. A 41-year-old woman was admitted to our hospital with a complaint of severe headache. Multiple intracranial vasospasms were noted on a brain CT angiogram and transfemoral cerebral angiography. However, intracranial hemorrhage was not revealed by brain MRI or CT. On day 3 after admission, weakness of both legs and urinary incontinence developed. Spine MRI showed C7~T6 spinal cord compression due to hyperacute stage of SDH. After hematoma evacuation, her symptoms gradually improved. We suggest that spinal cord evaluation should be considered in patients with headache who have ICVS, although intracranial hemorrhage would not be visible in brain images.
Adult ; Brain ; Cerebral Angiography ; Female ; Headache ; Hematoma ; Hematoma, Subdural, Spinal* ; Hemorrhage ; Humans ; Intracranial Hemorrhages* ; Leg ; Magnetic Resonance Imaging ; Spinal Cord ; Spinal Cord Compression ; Spine ; Subarachnoid Hemorrhage ; Urinary Incontinence ; Vasospasm, Intracranial*

Chronic subdural hematoma (CSDH) is a collection of old blood and its breakdown products between the surface of the brain parenchyma and the outermost layer called the dura. The most common treatment option for primary CSDH is burr-hole trephination; however, the treatment method for recurrent CSDH is still widely debated. An arachnoid cyst (AC) is a sac filled with cerebrospinal fluid located between the brain or spinal cord and the arachnoid membrane, which is one of the three meninges covering the brain or spinal cord. Although it is rare, the cyst is associated with CSDH in juveniles, and the recurrence rate of CSDH increases in such cases. Much of the literature has supported the preventive role of middle meningeal artery (MMA) embolization in recurrent CSDH. We report a 13-year-old male patient with recurrent CSDH and AC where the early intervention of MMA embolization was proven effective in preventing the further recurrence of CSDH.
Adolescent ; Arachnoid Cysts ; Arachnoid* ; Brain ; Cerebrospinal Fluid ; Early Intervention (Education) ; Embolization, Therapeutic ; Hematoma, Subdural, Chronic* ; Humans ; Male ; Membranes ; Meningeal Arteries* ; Meninges ; Recurrence ; Spinal Cord ; Trephining