Lumbar subdural hematoma detected after surgical treatment of chronic intracranial subdural hematoma: a case report.

Spinal subdural hematoma (SSDH), which can cause lower back pain, leg pain and weakness, is rare, and is usually associated with bleeding tendency, trauma, spinal vascular malformation, intraspinal tumor, or iatrogenic invasion. Only a few cases of SSDH after intracranial chronic subdural hematoma (CSDH) have been reported. We report a case of lumbar SSDH in the absence of predisposing factors after reoperation for recurrent intracranial CSDH that improved with conservative treatment.Approximately one month after falling, a 63-year-old woman was experiencing left hemiparesis and impaired orientation that was diagnosed as right intracranial CSDH by computed tomography (CT). Surgical treatment for the CSDH led to immediate improvement of her symptoms. On postoperative day 29, the right CSDH recurred with left hemiparesis, and successful reoperation relieved the symptoms within a few hours. One day after the second operation, very small acute subdural hematomas in regions along the left tentorium cerebelli and the left falx cerebri were found on CT. On day 31, she complained of sitting-induced bilateral radiating lower limb pain. Magnetic resonance imaging on day 34 showed an acute SSDH at L4-5 level and a sacral perineural cyst filled with hematoma, although her radiating pain tended to improve. She was treated conservatively and discharged without symptoms on day 44.Although SSDH is rare, it is important for neurosurgeons and physicians to consider the possibility of SSDH when lower limb pain or paresis occur after procedures with rapid intracranial pressure alteration such as drainage for intracranial CSDH.