Missed Intracranial Subdural Hematoma in a Case of Spontaneous Subdural Spinal Hematoma: A Rare Case Report and Literature Review

Introduction: Idiopathic spontaneous spinal subdural hematoma (ISSSDH) is uncommon in occurrence, and its association with concomitant intracranial subdural hematoma (ISDH) is very exceptional. Lack of recognition of ISDH in a patient with SSDH can lead to unanticipated events. We report a rare case of ISSSDH and unrecognized ISDH and treated surgically with a good outcome. Case Report: A 71-year-old gentleman presented with features of spinal neurogenic claudication of 2 weeks duration and was diagnosed to have ISSSDH of the lumbar spine based on magnetic resonance imaging (MRI). In view of an impending cauda equina syndrome, he underwent an emergency decompression through a laminectomy, durotomy, and clot evacuation from L2 to L5. The next day, he developed sudden-onset hemiparesis and altered sensorium. The computed tomography (CT) scan of the brain demonstrated an ISDH, for which emergency burr hole evacuation was done. The patient improved rapidly after the surgery and regained his normal power, sensorium, and achieved comfortable ambulation within a week. Follow-up CT of the brain and MRI scan of the spine revealed adequate decompression. Since the CT features of ISDH were of acute on chronic nature, we presume that it had existed before the onset of spinal symptoms. Conclusion: Through this very rare case, we highlight the importance of screening the brain pre-operatively in patients who present with sub-acute spontaneous spinal SDH.