1215. Spontaneous Spinal Subdural Hematoma Concurrent with Spontaneous Intracranial Subarachnoid Hemorrhage

Authors: Robert Rothrock, MD; Adam Li, BS; Johanna Fifi, MD; Christopher Kellner, MD; Chanland Roonprapunt, MD, PhD (New York, NY)

Introduction:

Spontaneous spinal subdural hematoma (S-SDH) is an uncommon complication in the setting of intracranial aneurysmal subarachnoid hemorrhage (SAH).  Little has been demonstrated regarding the management and outcomes of this unique clinical entity.

Methods:

A systematic review of the literature using the PRISMA guidelines was conducted on S-SDH in SAH to determine the defining characteristics, management, and outcomes in this patient population.  

Results:

11 reported cases were identified in the literature, and 1 additional case is reported. Intracranial sources of SAH included 8 patients with aneurysms, 1 with pseudoaneurysm, and 3 angiogram negative cases. Mean Hunt Hess grade was 2.6 (range 1-4), mean Fisher grade was 2.4 (range 1-4), mean time to presentation of S-SDH was 5.8 days from SAH (range 0-21), and most common location was lumbar (range C2-S2). At last follow up, 8 patients (67%) exhibited full/near full clinical recovery, 2 (17%) had continued weakness of the lower extremities, and 2 (17%) had expired. Mean modified Rankin score at last follow up was 2.6 (range 0-6). Patients with a worse clinical outcome (mRS > 2) tended to be angiogram negative (75% vs 0%), had less time to S-SDH presentation (0.8 vs 7.6 days), had higher modified Fisher grade (3.3 vs. 1.8), were on anticoagulation/antiplatelet medication (75% vs 0%), did not have CSF diversion at presentation (25% vs 75%), had pre-existing radiographic stenosis (75% vs 33%), and tended to have a cervical or thoracic S-SDH.

Conclusion:

S-SDH is an uncommon but reported complication of spontaneous aneurysmal SAH with better outcomes associated with lumbar location, delayed presentation of S-SDH in SAH course, CSF diversion, and lack of anticoagulation/ antiplatelet use. Conservative treatment may be sufficient in cases with lack of significant neurological deficits. More reported cases will allow higher understanding of clinical presentation and guidelines for management.