手術治療を行った特発性脊髄硬膜下血腫の1例

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  We report a case of spontaneous spinal subdural hematoma that was not associated with a coagulation abnormality. A 72-year-old woman was admitted to our department because of sudden back pain and motor weakness in both legs. There was no history of trauma, iatrogenic factor, or use of anticoagulant agents, and no laboratory evidence of a bleeding diathesis. Magnetic resonance imaging (MRI) showed a longitudinal, space-occupying lesion extending from C7 to T3 in the left posterolateral spinal canal. Based on the clinical and MRI findings, a cervicothoracic spinal epidural hematoma was diagnosed. The patient underwent a left hemilaminectomy from C6 through T4. A subdural hematoma was identified and evacuated. Angiography revealed no vascular malformations. Postoperatively, the patient had significant neurological recovery, and was discharged on foot 6 weeks after the surgery.

  It is important to consider the possibility of this clinical entity in patients who present with acute signs of cord compression, as a prompt diagnosis is essential for the successful treatment of spinal subdural hematoma. Differentiation of spontaneous spinal subdural hematoma from spinal epidural hematoma may be difficult and warrants close inspection of the MR images.