What is the clinical evidence from this study?

Study design: Case Report. Population: Acute spontaneous spinal subdural hematoma with Takotsubo cardiomyopathy (n=1). Intervention: Conservative treatment. Primary outcome: Clinical recovery.

May 1, 2022Open Access

Acute spontaneous spinal subdural hematoma presenting with Takotsubo cardiomyopathy: a rare case report and literature review

Key Result

Conservative treatment with supportive therapies led to the rapid resolution of myocardial injury and alleviation of neurological symptoms in a patient with acute spontaneous spinal subdural hematoma and Takotsubo cardiomyopathy.

Study Design

Type

Case Report (n=1)

Structured PICO

Population

A 52-year-old woman with acute spontaneous spinal subdural hematoma and concomitant Takotsubo cardiomyopathy, treated conservatively and followed for 11 months.

Intervention

Conservative treatment including dopamine, spironolactone, furosemide, metoprolol, and methylprednisolone.

Outcome

Resolution of symptoms and recovery of cardiac function.

Initial conservative treatment is a viable option for spontaneous spinal subdural hematoma presenting with Takotsubo cardiomyopathy.

Limitations

Tachycardia was initially misdiagnosed as sinus tachycardia, leading to treatment delay.
The mechanism of Takotsubo cardiomyopathy secondary to spinal subdural hematoma is still unclear.
The concentration of circulating catecholamines was not assessed.
Coronary angiography and ventricular angiography were not performed because the patient was in a critical condition.
Only two other cases were included in the literature review.

Abstract

Spontaneous spinal subdural hematoma (SSDH) is a rare and dangerous intraspinal hematoma that usually occurs in the thoracic vertebra. The influence of early cardiovascular changes secondary to spinal cord injury is an important emergent issue. Herein, we report a case of a middle-aged woman with clinical manifestations of back pain and motion and sensory disturbances below the level of spinal cord compression. During the disease course, she also developed changes indicative of myocardial injury, such as tachycardia, markedly increased concentrations of brain natriuretic peptide and cardiac troponin I, and a decreased left ventricular ejection fraction, which were consistent with the diagnosis of Takotsubo cardiomyopathy (TTC). After the administration of supportive therapies, the symptoms of myocardial injury rapidly resolved. With the absorption of SSDH, the symptoms and clinical signs were alleviated. We also reviewed the literature on cases of concomitant SSDH and TTC. This rare case broadens the symptom spectrum of SSDH and highlights the need for clinicians to be aware of concomitant SSDH and TTC. Initial conservative treatment is a viable option for SSDH with concomitant TTC. However, urgent surgery may be a better option if the SSDH progressively enlarges and causes spinal cord compression.

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