Spinal subdural hematomas (SSDH) are a rare but clinically significant cause of spinal cord compression that constitute a small portion of intradural spinal hematomas. Cervical SSDHs are infrequently documented in existing literature and are uncommon without coagulopathy, direct spinal trauma, spinal instrumentation, or intracranial hemorrhage. Accurate and timely diagnosis is challenging due to radiographic similarities with epidural hematomas and ambiguity in the timing and nature of symptoms. The patient was a 41-year-old male who presented to a Level 1 Trauma Center after being struck by a car while walking. While multiple minor, non-surgical injuries were sustained, initial spinal imaging revealed only mild prevertebral edema. On hospital day three, the patient experienced a significant neurological decline with resultant bilateral upper extremity weakness. Emergent repeat imaging discovered a large hematoma at the level of C3-4 with concomitant severe spinal cord compression and edema. He was taken emergently for anterior decompression; however, the hemorrhage was discovered to be subdural, prompting posterior cervical decompression with eventual resolution of his symptoms. This case highlights the diagnostic challenges of cervical SSDH in the absence of spinal fractures, ligamentous injury, coagulopathy, or recent instrumentation. While magnetic resonance imaging (MRI) may mischaracterize SSDHs for radiographically similar extradural pathology and misdirect surgical planning, intraoperative ultrasound afforded clarification of hematoma location and confirmed adequate decompression. Due to its highly atypical nature, we demonstrate the utility of ultrasound as an operative supplement in unclear hematoma management and the value of considering SSDH in the differential diagnosis of post-traumatic spinal cord compression.
Leoni et al. (Thu,) studied this question.