A spinal subdural hematoma induced by guidewire-based lumbar drainage in a patient with ruptured intracranial aneurysms

Abstract

We present a rare case of spinal subdural hematoma induced by guidewire-based lumbar drainage in a subarachnoid hemorrhage patient with a ruptured intracranial aneurysm. Decreased muscle strength and muscle tension of bilateral lower limbs were noted, and an MRI confirmed the spinal subdural hematoma from the sacral to the thoracic segments. The spinal subdural hematoma evacuation and spinal canal decompression were performed by laminectomy. However, the patient did not benefit from the surgery and developed lower limb muscle atrophy. The complication of the spinal subdural hematoma after lumbar drainage is extremely rare; only limited approaches are available for the treatment of spinal hematoma to improve the outcome and avoid severe consequences. Thus, the present case might suggest refraining from use of a guidewire during lumbar drainage for the prevention of spinal subdural hematoma and close observation of the related symptoms and signs for the early detection of spinal hematoma after the procedure. In addition, full decompression can be performed by complete hematoma evacuation and laminectomy of related segments for the treatment of spinal subdural hematoma induced by lumbar drainage.

Keywords

• lumbar drainage
• guidewire
• spinal subdural hematoma
• laminectomy
• spinal canal decompression