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Case No. 711
2025-02-01~2025-02-28
출제자 : 최혜정
Hit : 354
| Period | 2025-02-01~2025-02-28 |
|---|---|
| Diagnosis | Spinal subdural hematoma |
| Gender |
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| Age | 70 |
| Clinical information | 70세 남자환자의 spine MRI 이다. 진단은 ? |
| Discussion | Lumbar spinal subdural hematoma (SSH) is a rare but potentially serious condition associated with various factors such as anticoagulation, lumbar puncture, trauma, or spontaneous occurrence. SSH accounts for only 4.1% of all spinal hematomas (epidural, subarachnoid, subdural), as reported in a meta-analysis by Kreppel et al. Clinical Presentation: • Symptoms include: o Back pain o Radicular leg pain o Lower-extremity weakness or paralysis o Sensory disturbances o Urinary retention or incontinence • These symptoms overlap with other spinal pathologies, making imaging critical for diagnosis. Imaging Characteristics: • MRI findings may show a crescent-shaped collection in the posterior thecal sac. • The hematoma's appearance varies on MRI depending on its age. • A unique radiologic feature, the inverted Mercedes-Benz sign, has been described, showing nerve root and filum terminale encasement by hyperintense blood, distinguishing SSH from epidural hematomas. Differential Diagnoses: • Epidural hematomas • Lipomatosis • Abscess • Phlegmon • Tumor (e.g., lymphoma) Management: • Historically treated with surgery, but conservative management has shown good outcomes in some cases. • Prompt recognition of SSH and its radiologic signs, especially by emergency physicians and radiologists, is essential to prevent irreversible neurological injury. References 1. Pierce JL, Donahue JH, Nacey NC et-al. Spinal Hematomas: What a Radiologist Needs to Know. (2018) Radiographics : a review publication of the Radiological Society of North America, Inc. 38 (5): 1516-1535. doi:10.1148/rg.2018180099 - Pubmed 2. Manish K Kasliwa, Larry R Shannon et al. Inverted Mercedes Benz sign in lumbar spinal subdural hematoma J Emerg Med. 2014 Dec;47(6):692-3. doi: 10.1016/j.jemermed.2014.07.058 |
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