Advertisement

Der Radiologe

, Volume 48, Issue 10, pp 972–976 | Cite as

Spinales chronisches subdurales Hämatom

  • T. HagenEmail author
  • T. Lensch
Originalien

Zusammenfassung

Spinale subdurale Hämatome sind im Vergleich zu epiduralen Hämatomen selten, chronische Verlaufsformen noch seltener. Ursächlich sind neben Lumbalpunktionen und traumatischen Verletzungen auch Blutgerinnungsstörungen, Gefäßmalformationen und Tumoren. Aufgrund der Kompression von Myelon und Cauda equina kommt es zu zunehmenden Rücken- oder radikulären Schmerzen mit anschließender Paraparese sowie einer Darm- und Blasenstörung, weshalb in den meisten Fällen eine operative Entlastung durchgeführt wird. Magnetresonanztomographisch stellen sich die Hämatome meist als thorakale bzw. lumbale subdurale Raumforderungen dar, die Signalintensität variiert mit dem Blutungsalter. Wir berichten über den klinischen Verlauf und die bildgebende Diagnostik von 3 Patienten mit spinalen chronischen subduralen Hämatomen.

Schlüsselwörter

Spinales subdurales Hämatom Chronisches subdurales Hämatom Lendenwirbelsäule Brustwirbelsäule Magnetresonanztomographie (MRT) 

Chronic spinal subdural hematoma

Abstract

Compared with spinal epidural hematomas, spinal subdural hematomas are rare; chronic forms are even more uncommon. These hematomas are associated not only with lumbar puncture and spinal trauma, but also with coagulopathies, vascular malformations and tumors. Compression of the spinal cord and the cauda equina means that the patients develop increasing back or radicular pain, followed by paraparesis and bladder and bowel paralysis, so that in most cases surgical decompression is carried out. On magnetic resonance imaging these hematomas present as thoracic or lumbar subdural masses, their signal intensity varying with the age of the hematoma. We report the clinical course and the findings revealed by imaging that led to the diagnosis in three cases of chronic spinal subdural hematoma.

Keywords

Spinal subdural hematoma Chronic subdural hematoma Lumbar spine Thoracic spine Magnetic resonance imaging (MRI) 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Literatur

  1. 1.
    Bortolotti C, Wang H, Fraser K, Lanzino G (2004) Subacute spinal subdural hematoma after spontaneous resolution of cranial subdural hematoma: causal relationship or coincidence? Case report. J Neurosurg 100: 372–374PubMedGoogle Scholar
  2. 2.
    Boukobza M, Haddar D, Boissonet M, Merland JJ (2001) Spinal subdural haematoma: a study of three cases. Clin Radiol 56: 475–448PubMedCrossRefGoogle Scholar
  3. 3.
    Domenicucci M, Ramieri A, Ciapetta P, Delfini R (1999) Nontraumatic acute spinal subdural haematoma. J Neurosurg 91: 65–73PubMedGoogle Scholar
  4. 4.
    Gaitzsch J, Berney J (1984) Spinal subarachnoid haematoma of spontaneous origin and complicating anticoagulation. Surg Neurol 21: 534–538PubMedCrossRefGoogle Scholar
  5. 5.
    Hausmann O, Kirsch E, Radü E et al. (2001) Coagulopathy induced spinal intradural extramedullary haematoma: report of three cases and review of the literture. Acta Neurochir (Wien) 143: 135–140Google Scholar
  6. 6.
    Hung KS, Lui CC, Wang CH et al. (2002) Traumatic spinal subdural hematoma with spontaneous resolution. Spine 27: E534–E538PubMedCrossRefGoogle Scholar
  7. 7.
    Jimbo H, Asamoto S, Mitsuyama T et al. (2006) Spinal chronic subdural hematoma in association with anticoagulant therapy. Spine 31: E184–E187PubMedCrossRefGoogle Scholar
  8. 8.
    Kirsch EC, Khangure MS, Holthouse D, McAuliffe W (2000) Acute spontaneous subdural haematoma: MRI imaging features. Neuroradiology 42: 586–590PubMedCrossRefGoogle Scholar
  9. 9.
    Kreppel D, Antoniadis G, Seeling W (2003) Spinal hematoma: a literature survey with meta-analysis of 613 patients. Neurosurg Rev 26: 1–49PubMedCrossRefGoogle Scholar
  10. 10.
    Lecouvet FE, Annet L, Duprez TP et al. (2003) Uncommon magnetic resonance imaging observation of lumbar subdural hematoma with cranial origin. J Comput Assist Tomogr 27: 530–533PubMedCrossRefGoogle Scholar
  11. 11.
    Levy JM (1990) Spontaneous lumbar subdural hematoma. Am J Neuroradiol 11: 780–781PubMedGoogle Scholar
  12. 12.
    Masdeu JC, Breuer AC, Schoene WC (1979) Spinal subarachnoid hematomas: clue to a source of bleeding in traumatic lumbar puncture. Neurology 29: 872–876PubMedGoogle Scholar
  13. 13.
    Mashiko R, Noguchi S, Uemura K et al. (2006) Lumbosacral subdural hematoma. Neurol Med Chir (Tokyo) 46: 258–261CrossRefGoogle Scholar
  14. 14.
    Mavroudakis N (1992) Spontaneous spinal subdural hematoma: case report and review of the literature. Neurosurgery 30: 652PubMedCrossRefGoogle Scholar
  15. 15.
    Mavroudakis N, Levivier M, Rodesch G (1990) Central cord syndrome due to a spontaneously regressive spinal subdural hematoma. Neurology 40: 1306–1308PubMedGoogle Scholar
  16. 16.
    Nighoghossian N, Ruel JH, French P et al. (1990) Hématome sous-dural cervico-dorsal par intoxication aux raticides coumariniques. Rev Neurol 146: 221–223PubMedGoogle Scholar
  17. 17.
    Post MJ, Becerra JL, Madsen PW et al. (1994) Acute spinal subdural hematoma: MR and CT findings with pathologic correlates. AJNR Am J Neuroradiol 15: 1895–1905PubMedGoogle Scholar
  18. 18.
    Rader JP (1955) Chronic subdural hematoma of the spinal cord: report of a case. N Engl J Med 253: 374–376PubMedCrossRefGoogle Scholar
  19. 19.
    Schiller F, Neligan G, Budtz-Olsen O (1948) Surgery in haemophilia: a case of spinal subdural hematoma producing paraplegia. Lancet 2: 843–845Google Scholar
  20. 20.
    Schwerdtfeger K, Caspar W, Alloussi S et al. (1990) Acute intradural extramedullary hematoma: a non-surgical approach for spinal cord decompression. Neurosurgery 27: 313–314Google Scholar
  21. 21.
    Shimada Y, Sato K, Abe E et al. (1996) Spinal subdural hematoma. Skeletal Radiol 25: 477–480PubMedCrossRefGoogle Scholar
  22. 22.
    Shimizu S, Tachibana S, Maezawa H et al. (1999) Lumbar spinal subdural hematoma following craniotomy. Neurol Med Chir (Tokyo) 39: 299–301CrossRefGoogle Scholar
  23. 23.
    Silver JM, Wilkins RH (1991) Spinal subdural hematoma formation following ventriculo-peritoneal shunting für hydrocephalus. Acta Neurochir (Wien) 108: 159–162Google Scholar
  24. 24.
    Yamaguchi S, Hida K, Akino M et al. (2003) Spinal subdural hematoma: a sequela of a ruptured intracranial aneurysm? Surg Neurol 59: 408–412PubMedCrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag 2007

Authors and Affiliations

  1. 1.RadiologengemeinschaftAugsburgDeutschland

Personalised recommendations