LAUSR

BACKGROUND Spontaneous spinal subdural hematoma is rare but lead to severe nerve compression. According to symptom, surgery decompression and conservative treatment are justified option. We present a spontaneous spinal SDH case treated by decompression surgery for the lumbar region, and conservative observation for the thoracic region. Series of image of the disease course are available. CASEDESCRIPTION A 55 year-old woman, without malignancy nor coagulopathy history, presented progressive low back pain since 2 weeks ago. Progressive bilateral legs weakness happened since 1 week ago. On the day she called for help, she presented bilateral legs grade 2 muscle power and generalized back pain. There was no headache nor meningeal sign. Absent bilateral knee reflex was found. MR imaging showed T2 to T6, and T12 to L1 levels space occupy lesion in ventral and dorsal spinal canal, leading to cord compression. Due to rapid neurological function deterioration, emergent T12-L1 laminectomy was performed. We found T12-L1 tense dura sac with subdural hematoma ventral to the cord. Removal of SDH was performed. T2 to T6 levels was treated conservatively. She returned ambulant 1 week after operation. MR images at 3 months and 1 year later showed the SDH being absorbed and replaced by adhesive arachnoid cysts along the whole T and L spine. However, these lesions are asymptomatic until 2 years. CONCLUSION Surgical intervention is recommended in patients presenting with severe neurological deficits. Conservative treatment is a reasonable option for asymptomatic patients.