Spinal Subdural Hematoma With Paraplegia Mimicking Dorsolumbar Prolapsed Disc: A Case Report

Background and Importance: Spinal Subdural Hematoma (SSH) is a rare condition with an unknown incidence in the general population. Iatrogenic spinal subdural hematoma radiologically mimicking a prolapsed dorsolumbar disc has not been published in the literature. Case Presentation: A ۶۵-year-old female presented with altered sensorium and generalized weakness for ۳ days evaluated by a neurologist who diagnosed it as a metabolic encephalopathy with Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) with severe anemia and hypothyroidism. She underwent a diagnostic lumbar puncture and following which, within ۲۴ hours, she developed weakness of both the lower limbs. MRI of dorsolumbar spine was done which revealed D۱۲-L۱ extruded disc causing severe compression to the conus medullaris with D۱۲-L۲ subarachnoid lesion and cord edema. On opening the dura, a large organized hematoma on the anterior aspect of the conus was seen and evacuated. Conclusion: Spinal subdural hematoma presents with a spectrum of signs and symptoms. Although MRI is the investigation of choice but SSH presenting like a prolapsed intervertebral disc on MRI is one of its kinds and should be kept in mind since it carries a grave prognosis if not treated early with emergency decompression.

Keywords:

Subdural hematoma , Paraplegia , Prolapsed disc , Lumbar puncture , Conus medullaris