Limits...
Treatment of spontaneous cervical spinal subdural hematoma with methylprednisolone pulse therapy.

Song TJ, Lee JB, Choi YC, Lee KY, Kim WJ - Yonsei Med. J. (2011)

Bottom Line: A 57-year-old man was admitted for posterior neck pain and paraparesis which occurred an hour ago.MRI revealed a ventral subdural hematoma distributed from the level of C1 down to T3, compressing the spinal cord.Although emergent surgical decompression is necessary in most cases of spinal subdural hematoma, conservative management with steroid therapy could be effective.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, 712 Eonju-ro, Gangnam-gu, Seoul 135-720, Korea.

ABSTRACT
We report herein a case of hyperacute onset of spontaneous cervical spinal subdural hematoma treated with methylprednisolone pulse therapy that showed good results. A 57-year-old man was admitted for posterior neck pain and paraparesis which occurred an hour ago. MRI revealed a ventral subdural hematoma distributed from the level of C1 down to T3, compressing the spinal cord. Conservative management with methylprednisolone pulse therapy was administered considering the patient's poor general condition. Although emergent surgical decompression is necessary in most cases of spinal subdural hematoma, conservative management with steroid therapy could be effective.

Show MeSH

Related in: MedlinePlus

(A) MR imaging taken two hours after the onset of symptoms shows subdural hematoma distributed from C1 to T3 as high signal intensity on T2 weighted image (arrows). (B) The hematoma is revealed as isointensity on T1 weighted image at the C1 to T3 levels (arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3104457&req=5

Figure 1: (A) MR imaging taken two hours after the onset of symptoms shows subdural hematoma distributed from C1 to T3 as high signal intensity on T2 weighted image (arrows). (B) The hematoma is revealed as isointensity on T1 weighted image at the C1 to T3 levels (arrows).

Mentions: A 57-year-old man was admitted to the hospital with sudden and severe posterior neck and shoulder pains extending to the suboccipital region that developed paraparesis one hour ago. He denied any antecedent trauma, exertional activity, sneezing, valsalva maneuver, coitus, or vomiting. The patient had been on hypertension medication for 10 years and was diagnosed with chronic renal failure seven years ago. He had received hemodialysis three times per week for the past five years. The patient's last hemodialysis was performed two days before the admission. He had no previous history of bleeding tendency including taking antiplatelet or anticoagulant agents. At admission, blood pressure was 160/100 mmHg and pulse rate was normal range. Neurological examination of the cranial nerve function showed normal results. However, the patient showed motor weakness; Medical research council (MRC) grade 1/1 and spasticity in both upper and lower limbs. Sensory modality was normal, including pain, temperature, joint position, and vibration sense in feet and perineal region. Neck stiffness and Kernig's sign were observed. Deep tendon reflexes were mildly hyper-reflexed. Anal sphincter and bulbocarvenosus reflex were intact. According to the blood analysis, hemoglobin was 10.1 g/L, blood urea nitrogen was 54 mg/dL, and serum creatinine was 9.39 mg/dL. The white blood cell count, platelet count, bleeding time, prothrombin time, activated partial thromboplastin time, homocysteine, protein S, protein C antithrombin III, fibrinogen, and d-dimer were within the normal limits. Anticardiolipin antibody, lupus anticoagulant, and activated protein C resistance were negative. MRI of the cervical region at admission revealed a ventral subdural hematoma distributed from the level of C1 down to T3, compressing the spinal cord (Fig. 1). The lesion was hyperintense on the T2-weighted and isointense T1-weighted images. Brain CT imaging, excluding only associated cerebral hemorrhage, revealed old cerebral infarction in pons and ischemic change in bilateral periventricular white matter.


Treatment of spontaneous cervical spinal subdural hematoma with methylprednisolone pulse therapy.

Song TJ, Lee JB, Choi YC, Lee KY, Kim WJ - Yonsei Med. J. (2011)

(A) MR imaging taken two hours after the onset of symptoms shows subdural hematoma distributed from C1 to T3 as high signal intensity on T2 weighted image (arrows). (B) The hematoma is revealed as isointensity on T1 weighted image at the C1 to T3 levels (arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3104457&req=5

Figure 1: (A) MR imaging taken two hours after the onset of symptoms shows subdural hematoma distributed from C1 to T3 as high signal intensity on T2 weighted image (arrows). (B) The hematoma is revealed as isointensity on T1 weighted image at the C1 to T3 levels (arrows).
Mentions: A 57-year-old man was admitted to the hospital with sudden and severe posterior neck and shoulder pains extending to the suboccipital region that developed paraparesis one hour ago. He denied any antecedent trauma, exertional activity, sneezing, valsalva maneuver, coitus, or vomiting. The patient had been on hypertension medication for 10 years and was diagnosed with chronic renal failure seven years ago. He had received hemodialysis three times per week for the past five years. The patient's last hemodialysis was performed two days before the admission. He had no previous history of bleeding tendency including taking antiplatelet or anticoagulant agents. At admission, blood pressure was 160/100 mmHg and pulse rate was normal range. Neurological examination of the cranial nerve function showed normal results. However, the patient showed motor weakness; Medical research council (MRC) grade 1/1 and spasticity in both upper and lower limbs. Sensory modality was normal, including pain, temperature, joint position, and vibration sense in feet and perineal region. Neck stiffness and Kernig's sign were observed. Deep tendon reflexes were mildly hyper-reflexed. Anal sphincter and bulbocarvenosus reflex were intact. According to the blood analysis, hemoglobin was 10.1 g/L, blood urea nitrogen was 54 mg/dL, and serum creatinine was 9.39 mg/dL. The white blood cell count, platelet count, bleeding time, prothrombin time, activated partial thromboplastin time, homocysteine, protein S, protein C antithrombin III, fibrinogen, and d-dimer were within the normal limits. Anticardiolipin antibody, lupus anticoagulant, and activated protein C resistance were negative. MRI of the cervical region at admission revealed a ventral subdural hematoma distributed from the level of C1 down to T3, compressing the spinal cord (Fig. 1). The lesion was hyperintense on the T2-weighted and isointense T1-weighted images. Brain CT imaging, excluding only associated cerebral hemorrhage, revealed old cerebral infarction in pons and ischemic change in bilateral periventricular white matter.

Bottom Line: A 57-year-old man was admitted for posterior neck pain and paraparesis which occurred an hour ago.MRI revealed a ventral subdural hematoma distributed from the level of C1 down to T3, compressing the spinal cord.Although emergent surgical decompression is necessary in most cases of spinal subdural hematoma, conservative management with steroid therapy could be effective.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, 712 Eonju-ro, Gangnam-gu, Seoul 135-720, Korea.

ABSTRACT
We report herein a case of hyperacute onset of spontaneous cervical spinal subdural hematoma treated with methylprednisolone pulse therapy that showed good results. A 57-year-old man was admitted for posterior neck pain and paraparesis which occurred an hour ago. MRI revealed a ventral subdural hematoma distributed from the level of C1 down to T3, compressing the spinal cord. Conservative management with methylprednisolone pulse therapy was administered considering the patient's poor general condition. Although emergent surgical decompression is necessary in most cases of spinal subdural hematoma, conservative management with steroid therapy could be effective.

Show MeSH
Related in: MedlinePlus