Factors that predispose to subdural hematoma include:
Percutaneous spinal intervention
Trauma uncommon cause
A combination of any of the above
Symptoms are those of spinal cord compression or cauda equina syndrome, often presenting initially as back pain and/or radicular pain. Symptoms tend to develop more rapidly with subdural hematomas 3).
It is important to distinguish between subdural hematomas and other entities which can occupy the spinal subdural space:
Spinal subdural empyema: rare
Different history and clinical picture, including fever local extension or haematogenous spread, or iatrogenic behaves differently on MRI
Spinal subdural hygroma: CSF collection Appears as clumping of nerve roots in shape of inverted Mercedes-Benz sign
Injury to dura mater may be directly detected
Large hygroma can show MRI signs of craniospinal hypotension:
dural venous distension
decreased pontomesencephalic angle
Epidural lipomatosis: fat-sat sequences will help differentiation between early subacute SSDH and lipomatosis
Intradural-extramedullary mass: meningiomas and nerve sheath tumors (both common) enhance avidly, while arachnoid cysts follow CSF signal on all sequences
Arachnoiditis: nerve root clumping surrounded entirely by CSF (i.e. not the inverted Mercedes-Benz appearance)
Conservative treatment with watchful waiting (i.e. follow-up with serial MRIs) is acceptable for small collections. In case of significant neurologic defects, laminectomy with clot evacuation is done.
Although prompt diagnosis and emergent surgical intervention are important in acute spinal subdural hematoma (SSDH), some cases with spontaneous remission of symptom and hematoma without surgery have been reported.
Cervical and thoracic SSDH are associated with a worse outcome than lumbar SSDH, as is coexisting spinal subarachnoid hematoma (SSAH).
Farzan A, Pourbakhtyaran E, Moosavian T, Moosavian H. Spinal Subdural Hematomas in a Normal Child without Trauma History: A Case Report. Iran J Child Neurol. 2019 Summer;13(3):121-124. PubMed PMID: 31327977; PubMed Central PMCID: PMC6586447.