Case ReportLumbosacral Subdural Hematoma After Glioblastoma Multiforme Resection: Possible Radiographic Evidence for the Downward Migration of Intracranial Blood
Introduction
Spinal subdural hematomas (SSDHs) are rare and usually associated with bleeding diatheses due to hematologic disease or anticoagulation therapy, trauma, iatrogenic injury such as lumbar puncture or previous spine surgery, spinal vascular malformations, or intraspinal tumors.1, 2 In the absence of these risk factors, the occurrence of SSDHs after intracranial surgery is exceedingly rare.3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 We report a case of SSDH that developed after intracranial tumor resection.
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Case Report
The patient was a 75-year-old man with history of hypertension, prostate cancer, depression, and seizures. Magnetic resonance imaging (MRI) of the brain was obtained after the patient had 2 syncopal episodes. This revealed a necrotic, peripherally enhancing mass in the right anterior temporal lobe suggestive of a primary high-grade glioma. The patient underwent a right temporal craniotomy, and gross total resection of the tumor was achieved.
Although the patient had a nonlocalizing neurologic
Discussion and Literature Review
SSDH is a rare occurrence and usually is associated with coagulopathy (blood dyscrasias or therapeutic anticoagulation), trauma, iatrogenic injury (lumbar puncture or previous spine surgery), spinal vascular malformations, or intraspinal tumors.1, 2 Nontraumatic SSDHs occurring as a complication after intracranial surgery have been reported only in sporadic case reports in the literature.3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 There was no obvious etiology for the
Conclusions
We reported a case of a symptomatic lumbosacral SSDH that followed temporal glioblastoma multiforme resection in a patient with no known risk factors such as bleeding diathesis, trauma, lumbar puncture, spine surgery, spinal vascular malformation, or intraspinal tumor. We may have radiographic evidence of intracranial blood as it migrates downward into the cervical spine (Figure 1C) before settling in the most gravity-dependent portion of the lumbosacral spine. The degree to which subarachnoid
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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