Spontaneous Spinal Subdural Hematoma of Intracranial Origin

Why Should an Emergency Physician be Aware of This?

This case report reveals an interesting and rare case of intracranial SDH presenting as lower back pain. In our patient, an MRI demonstrated spinal SDH and additional investigation revealed intracranial SDH. It is postulated that blood in the intracranial subdural space can migrate due to gravity and cause spinal SDH. A diagnosis of spinal SDH and knowledge of this mechanism should prompt the emergency physician to inquire about a history of headaches, nausea, or vomiting, which, if present, should heighten suspicion for intracranial pathology. Likewise, spinal SDH should be a differential diagnosis in a patient with a recent history of intracranial SDH who presents with back pain or sensorimotor deficits. Awareness of concomitant intracranial and spinal SDH can aid in a more timely and complete diagnosis, and can ultimately change management in emergency department patients requiring anticoagulant reversal or surgical intervention.