J Korean Neurosurg Soc.  2014 Dec;56(6):527-530. 10.3340/jkns.2014.56.6.527.

Intracranial Extension of Spinal Subarachnoid Hematoma Causing Severe Cerebral Vasospasm

• Nam KH
• Lee JI
• Choi BK
• Han IH

• KMID: 2191152
• DOI: http://doi.org/10.3340/jkns.2014.56.6.527

Abstract

Spinal subarachnoid hemorrhages (SAH) can extend into the intracranial subarachnoid space, but, severe cerebral vasospasm is rare complication of the extension of intracranial SAH from a spinal subarachnoid hematoma. A 67-year-old woman started anticoagulant therapy for unstable angina. The next day, she developed severe back pain and paraplegia. MRI showed intradural and extramedullar low signal intensity at the T2-3, consistent with intradural hematoma. High signal intensity was also noted in the spinal cord from C5 to T4. We removed subarachnoid hematoma compressing the spinal cord. The following day, the patient complained of severe headache. Brain CT revealed SAH around both parietal lobes. Three days later, her consciousness decreased and left hemiplegia also developed. Brain MRI demonstrated multiple cerebral infarctions, mainly in the right posterior cerebral artery territory, left parietal lobe and right watershed area. Conventional cerebral angiography confirmed diffuse severe vasospasm of the cerebral arteries. After intensive care for a month, the patient was transferred to the rehabilitation department. After 6 months, neurologic deterioration improved partially. We speculate that surgeons should anticipate possible delayed neurological complications due to cerebral vasospasm if intracranial SAH is detected after spinal subarachnoid hematoma.

Keyword

Spinal subarachnoid hematoma; Intracranial subarachnoid hemorrhage; Vasospasm; Cerebral infarction

MeSH Terms

Aged
Angina, Unstable
Back Pain
Brain
Cerebral Angiography
Cerebral Arteries
Cerebral Infarction
Consciousness
Female
Headache
Hematoma*
Hemiplegia
Humans
Critical Care
Magnetic Resonance Imaging
Paraplegia
Parietal Lobe
Posterior Cerebral Artery
Rehabilitation
Spinal Cord
Subarachnoid Hemorrhage
Subarachnoid Space
Vasospasm, Intracranial*

Figure

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  Fig. 1 Thoracic T2-weighted MRI showing intradural extramedullary low signal intensity at the T2-3 levels, consistent with spinal subarachnoid hematomas, and high spinal cord signal intensity from C5 to T4.

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  Fig. 2 Intraoperative finding showing thick hematoma compressing the spinal cord beneath the arachnoid membrane.

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  Fig. 3 CT image showing SAH in both parietal portions. SAH : spinal subarachnoid hemorrhages.

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  Fig. 4 MRI diffuse weighted (A) and CT (B) images showing acute infarction in the both occipital lobes.

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  Fig. 5 A : Conventional cerebral angiogram demonstrating diffuse cerebral arteries vasospasm, predominantly at the right middle cerebral artery. B : CT perfusion image demonstrating perfusion in both occipital and temporal lobes.

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