Age / Sex : 57 / M

Age / Sex : 57/M

Chief complaint : Abrupt back pain (20-12-2008, 8 p.m.)

                            CT for r/o aortic dissection.

subdural hematoma

Discussion

Findings:

MRI (21, Dec); limited study with only sagittal T2WI

A sagittal T2WI shows spindle shaped mass with intermediate to high signal intensity in posterior aspect of the spinal cord at the level of C7.

MRI (22, Dec)

A sagittal and axial T1WI shows central high signal intensity in the lesion and intermediate to low signal intensity on T2WI.

Fat suppressed T1WI with contrast enhancement shows peripheral enhancement of the lesion with subtle enhancement within the lesion

Differential Diagnosis: not necessary, but EDH, tumorous condition such as fibrous tumor or underlying other tumor including small hemangioma or AVM must be ruled out

Diagnosis: Acute subdural hemorrhage (SDH) in spine

Discussion:

The back pain was decreased on 23 Dec. and was disappeared completely on 25 Dec.

Etiology of spinal SDH

•         Trauma

•         Bleeding diathesis (54% of reported cases) - anticoagulation, coagulopathy (hemophilia, leukemia, TTP, polycytemia)

•         Iatrogenic coagulation parameters

•         lumbar puncture, spinal anesthesia.

•         Neoplasm

•         Arteriovenous malformation

•         Post-operative complication

•         Spontaneous (15%)  

Symptom; Acute onset of neck or back pain, radicularpain.

Location; Thoracolumbar > lumbar or lumbosacra > cervical

SDH is located inner portion of the low signal intensity line representing the dura matter and shows localization rather than spread as in the EDH