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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.

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(A) CT imaging taken one month after the onset of symptoms shows subdural hematoma in C3 lesion (arrow). (B) The spinal cord at the C7 level is relatively intact.
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Figure 2: (A) CT imaging taken one month after the onset of symptoms shows subdural hematoma in C3 lesion (arrow). (B) The spinal cord at the C7 level is relatively intact.

Mentions: Conservative management with methylprednisolone pulse therapy was administered, despite the extensiveness of the lesion, because of the patient's poor general condition and difficulties associated with general anesthesia and surgery. One g of methylprednisolone per day was intravenously infused for five days. Then he was placed on oral prednisolone 60 mg/d, which was tapered to 20 mg per day over the following two months. Hemodialysis was continued three times per week. The paraplegia of this patient was rapidly recovered after two days of steroid infusion. After the third day of steroid pulse, the patient regained good motor power in both upper and lower limbs (MRC grade 40/40), although he could not walk. After four weeks from first developed weakness, the patient was fully recovered motor weakness (MRC grade 4+/4+). He had minimal spasticity in both lower legs, but did not show bladder nor bowel control problems. The light touch, pain, position, and vibration sensations remained normal. Follow up spine CT scan revealed that subdural hematoma at C3-C4, left paramedian area and other levels were relatively intact (Fig. 2).


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) CT imaging taken one month after the onset of symptoms shows subdural hematoma in C3 lesion (arrow). (B) The spinal cord at the C7 level is relatively intact.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: (A) CT imaging taken one month after the onset of symptoms shows subdural hematoma in C3 lesion (arrow). (B) The spinal cord at the C7 level is relatively intact.
Mentions: Conservative management with methylprednisolone pulse therapy was administered, despite the extensiveness of the lesion, because of the patient's poor general condition and difficulties associated with general anesthesia and surgery. One g of methylprednisolone per day was intravenously infused for five days. Then he was placed on oral prednisolone 60 mg/d, which was tapered to 20 mg per day over the following two months. Hemodialysis was continued three times per week. The paraplegia of this patient was rapidly recovered after two days of steroid infusion. After the third day of steroid pulse, the patient regained good motor power in both upper and lower limbs (MRC grade 40/40), although he could not walk. After four weeks from first developed weakness, the patient was fully recovered motor weakness (MRC grade 4+/4+). He had minimal spasticity in both lower legs, but did not show bladder nor bowel control problems. The light touch, pain, position, and vibration sensations remained normal. Follow up spine CT scan revealed that subdural hematoma at C3-C4, left paramedian area and other levels were relatively intact (Fig. 2).

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