Korean J Neurotrauma.  2016 Oct;12(2):159-162. 10.13004/kjnt.2016.12.2.159.

Spinal Subarachnoid Hemorrhage Migrated from Traumatic Intracranial Subarachnoid Hemorrhage

• Kim TJ
• Koh EJ
• Cho KT

• KMID: 2356793
• DOI: http://doi.org/10.13004/kjnt.2016.12.2.159

Abstract

Very rarely, spinal subarachnoid hemorrhage (SSAH) can occur without any direct spinal injury in patients with traumatic intracranial SAH. A-59-year-old male with traumatic intracranial subarachnoid hemorrhage (SAH) presented with pain and numbness in his buttock and thigh two days after trauma. Pain and numbness rapidly worsened and perianal numbness and voiding difficulty began on the next day. Magnetic resonance imaging showed intraspinal hemorrhage in the lumbosacral region. The cauda equina was displaced and compressed. Emergent laminectomy and drainage of hemorrhage were performed and SSAH was found intraoperatively. The symptoms were relieved immediately after the surgery. Patients with traumatic intracranial hemorrhage who present with delayed pain or neurological deficits should be evaluated for intraspinal hemorrhage promptly, even when the patients had no history of direct spinal injury and had no apparent symptoms related to the spinal injury in the initial period of trauma.

Keyword

Subarachnoid hemorrhage; Spine; Brain injuries

MeSH Terms

Brain Injuries
Buttocks
Cauda Equina
Drainage
Hemorrhage
Humans
Hypesthesia
Intracranial Hemorrhage, Traumatic
Laminectomy
Lumbosacral Region
Magnetic Resonance Imaging
Male
Spinal Injuries
Spine
Subarachnoid Hemorrhage*
Thigh

Figure

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  FIGURE 1 (A) Brain computed tomography scan shows epidural hematoma in the right frontal lobe and (B) subarachnoid hemorrhage in the ambient cistern (arrow).

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  FIGURE 2 (A) Brain computed tomography scan shows decrease in the thickness of epidural hematoma and (B) resolution of subarachnoid hemorrhage (arrow).

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  FIGURE 3 (A) Lumbar spine magnetic resonance imaging shows fusiform lesions with low signal intensity in the T2-sagittal image (arrow) and (B) iso-signal intensity in the T1-sagittal image (arrow) (C) within the dorsal aspect of the spinal canal at the L5 and S1 level. T2-axial image shows low signal intensity lesion within the thecal sac (arrow) which displaces the cauda equina laterally (arrow head).

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