Acute Spinal Subarachnoid Hemorrhage: Case Report Cured by Continuous Cerebrospinal Fluid Drainage by Lumbar Puncture

Junfu Li; Dianshuang Xu; Zhiyong Chen; Wei Li; Maoying Zhang; Zhaoming Li

doi:doi:10.11648/j.ijn.20210501.22

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Acute Spinal Subarachnoid Hemorrhage: Case Report Cured by Continuous Cerebrospinal Fluid Drainage by Lumbar Puncture

Junfu Li, Dianshuang Xu, Zhiyong Chen, Wei Li, Maoying Zhang, Zhaoming Li

Published in International Journal of Neurosurgery (Volume 5, Issue 1)

Received: 31 May 2021 Accepted: 17 June 2021 Published: 26 June 2021

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Abstract

Background: Spinal subarachnoid hemorrhage (SSH) is a rare condition that can lead to severe neurological deficits. Clinicians should consider SSH when neurological deficits such as low back pain, pain hyperalgesia, paraplegia, and urinary and fecal incontinence are present. There is much debate as to whether SSH should be treated surgically or conservatively. There are few reports in the literature about this disease. In this paper, we report a case of SSH in terms of etiology, clinical manifestations, diagnosis and treatment. Methods: A case of SSH in our hospital was retrospectively analyzed in terms of etiology, pathogenesis, clinical manifestations, diagnosis and treatment. Results: The possible etiology of SSH in this case was due to rapid changes in intra-thoracic and intra-abdominal pressure due to prolonged bending, which caused tearing of the blood vessels in the subarachnoid space. The patient has returned to normal life with continuous lumbar puncture for cerebrospinal fluid drainage. Conclusion: We report a case of SSH with typical symptoms of back pain, sensory, motor and autonomic dysfunction. MRI is used as the method of choice to diagnose SSH, which is typically characterized by the lumbar sedimentation sign. Lumbar puncture for continuous drainage of cerebrospinal fluid is simple and less invasive, and may be considered by neurosurgeons as the treatment of choice for SSH, with further surgical treatment considered if results are poor.

Published in	International Journal of Neurosurgery (Volume 5, Issue 1)
DOI	10.11648/j.ijn.20210501.22
Page(s)	52-56
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Spinal Subarachnoid Hemorrhage (SSH), Continuous Cerebrospinal Fluid Drainage, Lumbar Puncture, Conservative Treatment, MRI, Paraplegia

References

[1]	Karakosta A, Kyrallidou A, Chapsa C, Pouliou A. Acute spinal subarachnoid haematoma following spinal anaesthesia treated conservatively: case report. Eur J Anaesthesiol. 2011 May; 28 (5): 388-90. doi: 10.1097/EJA.0b013e328343081c. PMID: 21499202.
[2]	Domenicucci M, Ramieri A, Paolini S, Russo N, Occhiogrosso G, Di Biasi C, Delfini R. Spinal subarachnoid hematomas: our experience and literature review. Acta Neurochir (Wien). 2005 Jul; 147 (7): 741-50; discussion 750. doi: 10.1007/s00701-004-0458-2. PMID: 15711890.
[3]	Plotkin R, Ronthal M, Froman C. Spontaneous spinal subarachnoid haemorrhage. Report of 3 cases. J Neurosurg. 1966 Oct; 25 (4): 443-6. doi: 10.3171/jns.1966.25.4.0443. PMID: 5925716.
[4]	Kunz U. Spinal hematoma: a literature survey with meta-analysis of 613 patients. Neurosurg Rev. 2003 Jan; 26 (1): 52. doi: 10.1007/s10143-002-0234-9. Epub 2002 Sep 24. PMID: 12520317.
[5]	Pierce JL, Donahue JH, Nacey NC, Quirk CR, Perry MT, Faulconer N, Falkowski GA, Maldonado MD, Shaeffer CA, Shen FH. Spinal Hematomas: What a Radiologist Needs to Know. Radiographics. 2018 Sep-Oct; 38 (5): 1516-1535. doi: 10.1148/rg.2018180099. PMID: 30207937.
[6]	Furlan JC, Noonan V, Cadotte DW, Fehlings MG. Timing of decompressive surgery of spinal cord after traumatic spinal cord injury: an evidence-based examination of pre-clinical and clinical studies. J Neurotrauma. 2011 Aug; 28 (8): 1371-99. doi: 10.1089/neu.2009.1147. Epub 2010 Mar 4. PMID: 20001726; PMCID: PMC3143409.
[7]	Rafter D, Vasdev R, Hurrelbrink D, Gormley M, Chettupally T, Shen FX, Samadani U. Litigation risks despite guideline adherence for acute spinal cord injury: time is spine. Neurosurg Focus. 2020 Nov; 49 (5): E17. doi: 10.3171/2020.8.FOCUS20607. PMID: 33130619.
[8]	Kirshblum SC, Burns SP, Biering-Sorensen F, Donovan W, Graves DE, Jha A, Johansen M, Jones L, Krassioukov A, Mulcahey MJ, Schmidt-Read M, Waring W. International standards for neurological classification of spinal cord injury (revised 2011). J Spinal Cord Med. 2011 Nov; 34 (6): 535-46. doi: 10.1179/204577211X13207446293695. PMID: 22330108; PMCID: PMC3232636.
[9]	Komiyama M, Yasui T, Sumimoto T, Fu Y. Spontaneous spinal subarachnoid hematoma of unknown pathogenesis: case reports. Neurosurgery. 1997 Sep; 41 (3): 691-3; discussion 693-4. doi: 10.1097/00006123-199709000-00040. PMID: 9310992.
[10]	Hong JH. Spontaneous spinal subarachnoid haemorrhage and subdural haematoma upon customary bowing: a case report. Br J Neurosurg. 2020 Apr 29: 1-2. doi: 10.1080/02688697.2020.1759778. Epub ahead of print. PMID: 32347123.
[11]	Bozzo A, Marcoux J, Radhakrishna M, Pelletier J, Goulet B. The role of magnetic resonance imaging in the management of acute spinal cord injury. J Neurotrauma. 2011 Aug; 28 (8): 1401-11. doi: 10.1089/neu.2009.1236. Epub 2010 Aug 30. PMID: 20388006; PMCID: PMC3143391.
[12]	Tewari MK, Gifti DS, Singh P, Khosla VK, Mathuriya SN, Gupta SK, Pathak A. Diagnosis and prognostication of adult spinal cord injury without radiographic abnormality using magnetic resonance imaging: analysis of 40 patients. Surg Neurol. 2005 Mar; 63 (3): 204-9; discussion 209. doi: 10.1016/j.surneu.2004.05.042. PMID: 15734500.
[13]	Crossley RA, Raza A, Adams WM. The lumbar sedimentation sign: spinal MRI findings in patients with subarachnoid haemorrhage with no demonstrable intracranial aneurysm. Br J Radiol. 2011 Mar; 84 (999): 279-81. doi: 10.1259/bjr/68122723. PMID: 21325365; PMCID: PMC3473883.
[14]	Anderson TL, Morris JM, Wald JT, Kotsenas AL. Imaging Appearance of Advanced Chronic Adhesive Arachnoiditis: A Retrospective Review. AJR Am J Roentgenol. 2017 Sep; 209 (3): 648-655. doi: 10.2214/AJR.16.16704. Epub 2017 Jun 22. PMID: 28639826.
[15]	Holtås S, Heiling M, Lönntoft M. Spontaneous spinal epidural hematoma: findings at MR imaging and clinical correlation. Radiology. 1996 May; 199 (2): 409-13. doi: 10.1148/radiology.199.2.8668786. PMID: 8668786.
[16]	Fehlings MG, Tator CH. An evidence-based review of decompressive surgery in acute spinal cord injury: rationale, indications, and timing based on experimental and clinical studies. J Neurosurg. 1999 Jul; 91 (1 Suppl): 1-11. doi: 10.3171/spi.1999.91.1.0001. PMID: 10419353.
[17]	Tovi D, Nilsson IM. Increased fibrinolytic activity and fibrin degradation products after experimental intracerebral haemorrhage. Acta Neurol Scand. 1972; 48 (4): 403-15. doi: 10.1111/j.1600-0404.1972.tb07562.x. PMID: 5072651.
[18]	Rengachary SS, Murphy D. Subarachnoid hematoma following lumbar puncture causing compression of the cauda equina. Case report. J Neurosurg. 1974 Aug; 41 (2): 252-4. doi: 10.3171/jns.1974.41.2.0252. PMID: 4841881.
[19]	Gaitzsch J, Berney J. Spinal subarachnoid hematoma of spontaneous origin and complicating anticoagulation. Report of four cases and review of the literature. Surg Neurol. 1984 Jun; 21 (6): 534-8. doi: 10.1016/0090-3019(84)90265-9. PMID: 6719324.
[20]	Park JH, Kim JY. Iatrogenic Spinal Subarachnoid Hematoma after Diagnostic Lumbar Puncture. Korean J Spine. 2017 Dec; 14 (4): 158-161. doi: 10.14245/kjs.2017.14.4.158. Epub 2017 Dec 31. PMID: 29301177; PMCID: PMC5769933.
[21]	Brown MW, Yilmaz TS, Kasper EM. Iatrogenic spinal hematoma as a complication of lumbar puncture: What is the risk and best management plan? Surg Neurol Int. 2016 Aug 29; 7 (Suppl 22): S581-9. doi: 10.4103/2152-7806.189441. PMID: 27625895; PMCID: PMC5009572.
[22]	Spanu G, Berlanda P, Rodriguez y Baena R. Spinal subdural haematoma: a rare complication of lumbar puncture. Case report and review of the literature. Neurochirurgia (Stuttg). 1988 Sep; 31 (5): 157-9. doi: 10.1055/s-2008-1053925. PMID: 3068561.
[23]	Czuczman AD, Thomas LE, Boulanger AB, Peak DA, Senecal EL, Brown DF, Marill KA. Interpreting red blood cells in lumbar puncture: distinguishing true subarachnoid hemorrhage from traumatic tap. Acad Emerg Med. 2013 Mar; 20 (3): 247-56. doi: 10.1111/acem.12095. PMID: 23517256.

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APA Style

Junfu Li, Dianshuang Xu, Zhiyong Chen, Wei Li, Maoying Zhang, et al. (2021). Acute Spinal Subarachnoid Hemorrhage: Case Report Cured by Continuous Cerebrospinal Fluid Drainage by Lumbar Puncture. International Journal of Neurosurgery, 5(1), 52-56. https://doi.org/10.11648/j.ijn.20210501.22

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ACS Style

Junfu Li; Dianshuang Xu; Zhiyong Chen; Wei Li; Maoying Zhang, et al. Acute Spinal Subarachnoid Hemorrhage: Case Report Cured by Continuous Cerebrospinal Fluid Drainage by Lumbar Puncture. Int. J. Neurosurg. 2021, 5(1), 52-56. doi: 10.11648/j.ijn.20210501.22

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AMA Style

Junfu Li, Dianshuang Xu, Zhiyong Chen, Wei Li, Maoying Zhang, et al. Acute Spinal Subarachnoid Hemorrhage: Case Report Cured by Continuous Cerebrospinal Fluid Drainage by Lumbar Puncture. Int J Neurosurg. 2021;5(1):52-56. doi: 10.11648/j.ijn.20210501.22

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@article{10.11648/j.ijn.20210501.22,
  author = {Junfu Li and Dianshuang Xu and Zhiyong Chen and Wei Li and Maoying Zhang and Zhaoming Li},
  title = {Acute Spinal Subarachnoid Hemorrhage: Case Report Cured by Continuous Cerebrospinal Fluid Drainage by Lumbar Puncture},
  journal = {International Journal of Neurosurgery},
  volume = {5},
  number = {1},
  pages = {52-56},
  doi = {10.11648/j.ijn.20210501.22},
  url = {https://doi.org/10.11648/j.ijn.20210501.22},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijn.20210501.22},
  abstract = {Background: Spinal subarachnoid hemorrhage (SSH) is a rare condition that can lead to severe neurological deficits. Clinicians should consider SSH when neurological deficits such as low back pain, pain hyperalgesia, paraplegia, and urinary and fecal incontinence are present. There is much debate as to whether SSH should be treated surgically or conservatively. There are few reports in the literature about this disease. In this paper, we report a case of SSH in terms of etiology, clinical manifestations, diagnosis and treatment. Methods: A case of SSH in our hospital was retrospectively analyzed in terms of etiology, pathogenesis, clinical manifestations, diagnosis and treatment. Results: The possible etiology of SSH in this case was due to rapid changes in intra-thoracic and intra-abdominal pressure due to prolonged bending, which caused tearing of the blood vessels in the subarachnoid space. The patient has returned to normal life with continuous lumbar puncture for cerebrospinal fluid drainage. Conclusion: We report a case of SSH with typical symptoms of back pain, sensory, motor and autonomic dysfunction. MRI is used as the method of choice to diagnose SSH, which is typically characterized by the lumbar sedimentation sign. Lumbar puncture for continuous drainage of cerebrospinal fluid is simple and less invasive, and may be considered by neurosurgeons as the treatment of choice for SSH, with further surgical treatment considered if results are poor.},
 year = {2021}
}

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TY - JOUR
T1 - Acute Spinal Subarachnoid Hemorrhage: Case Report Cured by Continuous Cerebrospinal Fluid Drainage by Lumbar Puncture
AU - Junfu Li
AU - Dianshuang Xu
AU - Zhiyong Chen
AU - Wei Li
AU - Maoying Zhang
AU - Zhaoming Li
Y1 - 2021/06/26
PY - 2021
N1 - https://doi.org/10.11648/j.ijn.20210501.22
DO - 10.11648/j.ijn.20210501.22
T2 - International Journal of Neurosurgery
JF - International Journal of Neurosurgery
JO - International Journal of Neurosurgery
SP - 52
EP - 56
PB - Science Publishing Group
SN - 2640-1959
UR - https://doi.org/10.11648/j.ijn.20210501.22
AB - Background: Spinal subarachnoid hemorrhage (SSH) is a rare condition that can lead to severe neurological deficits. Clinicians should consider SSH when neurological deficits such as low back pain, pain hyperalgesia, paraplegia, and urinary and fecal incontinence are present. There is much debate as to whether SSH should be treated surgically or conservatively. There are few reports in the literature about this disease. In this paper, we report a case of SSH in terms of etiology, clinical manifestations, diagnosis and treatment. Methods: A case of SSH in our hospital was retrospectively analyzed in terms of etiology, pathogenesis, clinical manifestations, diagnosis and treatment. Results: The possible etiology of SSH in this case was due to rapid changes in intra-thoracic and intra-abdominal pressure due to prolonged bending, which caused tearing of the blood vessels in the subarachnoid space. The patient has returned to normal life with continuous lumbar puncture for cerebrospinal fluid drainage. Conclusion: We report a case of SSH with typical symptoms of back pain, sensory, motor and autonomic dysfunction. MRI is used as the method of choice to diagnose SSH, which is typically characterized by the lumbar sedimentation sign. Lumbar puncture for continuous drainage of cerebrospinal fluid is simple and less invasive, and may be considered by neurosurgeons as the treatment of choice for SSH, with further surgical treatment considered if results are poor.
VL - 5
IS - 1
ER -

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Author Information

Junfu Li

Department of Neurosurgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
Dianshuang Xu

Office of the President, Chaoshan Hospital, The First Hospital of Jinan University, Chaoshan, China
Zhiyong Chen

Department of Neurosurgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
Wei Li

Department of Neurosurgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
Maoying Zhang

Department of Neurosurgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
Zhaoming Li

Department of Neurosurgery, The First Affiliated Hospital of Jinan University, Guangzhou, China

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APA Style

Junfu Li, Dianshuang Xu, Zhiyong Chen, Wei Li, Maoying Zhang, et al. (2021). Acute Spinal Subarachnoid Hemorrhage: Case Report Cured by Continuous Cerebrospinal Fluid Drainage by Lumbar Puncture. International Journal of Neurosurgery, 5(1), 52-56. https://doi.org/10.11648/j.ijn.20210501.22

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ACS Style

Junfu Li; Dianshuang Xu; Zhiyong Chen; Wei Li; Maoying Zhang, et al. Acute Spinal Subarachnoid Hemorrhage: Case Report Cured by Continuous Cerebrospinal Fluid Drainage by Lumbar Puncture. Int. J. Neurosurg. 2021, 5(1), 52-56. doi: 10.11648/j.ijn.20210501.22

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AMA Style

Junfu Li, Dianshuang Xu, Zhiyong Chen, Wei Li, Maoying Zhang, et al. Acute Spinal Subarachnoid Hemorrhage: Case Report Cured by Continuous Cerebrospinal Fluid Drainage by Lumbar Puncture. Int J Neurosurg. 2021;5(1):52-56. doi: 10.11648/j.ijn.20210501.22

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@article{10.11648/j.ijn.20210501.22,
  author = {Junfu Li and Dianshuang Xu and Zhiyong Chen and Wei Li and Maoying Zhang and Zhaoming Li},
  title = {Acute Spinal Subarachnoid Hemorrhage: Case Report Cured by Continuous Cerebrospinal Fluid Drainage by Lumbar Puncture},
  journal = {International Journal of Neurosurgery},
  volume = {5},
  number = {1},
  pages = {52-56},
  doi = {10.11648/j.ijn.20210501.22},
  url = {https://doi.org/10.11648/j.ijn.20210501.22},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijn.20210501.22},
  abstract = {Background: Spinal subarachnoid hemorrhage (SSH) is a rare condition that can lead to severe neurological deficits. Clinicians should consider SSH when neurological deficits such as low back pain, pain hyperalgesia, paraplegia, and urinary and fecal incontinence are present. There is much debate as to whether SSH should be treated surgically or conservatively. There are few reports in the literature about this disease. In this paper, we report a case of SSH in terms of etiology, clinical manifestations, diagnosis and treatment. Methods: A case of SSH in our hospital was retrospectively analyzed in terms of etiology, pathogenesis, clinical manifestations, diagnosis and treatment. Results: The possible etiology of SSH in this case was due to rapid changes in intra-thoracic and intra-abdominal pressure due to prolonged bending, which caused tearing of the blood vessels in the subarachnoid space. The patient has returned to normal life with continuous lumbar puncture for cerebrospinal fluid drainage. Conclusion: We report a case of SSH with typical symptoms of back pain, sensory, motor and autonomic dysfunction. MRI is used as the method of choice to diagnose SSH, which is typically characterized by the lumbar sedimentation sign. Lumbar puncture for continuous drainage of cerebrospinal fluid is simple and less invasive, and may be considered by neurosurgeons as the treatment of choice for SSH, with further surgical treatment considered if results are poor.},
 year = {2021}
}

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