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Subdural Hygroma of the Lumbar Spine: First Reported Case 2008

General Spine

Sangit B Malliah, MD,
Todd Siegal, MD, Non ASSR Member
Brown Michelle, MD, Non ASSR Member
Cyrus Khorrami, MD, Non ASSR Member

Excerpta Extraordinaire

Excerpta

Summary: A 47 year old male presented for a lumbar spine MRI after a fall directly on his back from an elevation of a few feet. An MRI of the lumbar spine demonstrated a fluid intensity signal encircling the lumbar spine spanning over multiple lumbar vertebral levels. This fluid was in a subdural location interposed between the dura and arachnoid layers of the thecal sac with both meningeal layers identified. There was no neural foraminal extension. There was no infiltration of the epidural fat. The signal intensity of the fluid followed CSF signal intensity on all imaging sequences. Post contrast imaging was performed four weeks later which demonstrated no enhancement and no change in the imaging findings. Overall, findings were compatible with a post-traumatic subdural hygroma of the lumbar spine. Hematoma was considered less likely as there was no change in the imaging findings over a four week period.
This abnormality appears to be on the spectrum of various types of CSF leaks. These include true meningeal diverticulum which may be due to congenital weakness of the meninges as seen in various connective tissue disorders. Pseudomeningoceles are another form of CSF leak due to tears of the dura-arachnoid mater resulting in epidural CSF collections. Although CSF leaks are often asymptomatic, they may cause low-back pain, headaches, nerve root entrapment and intracranial hypotension. After consultation with orthopedic surgery, conservative management was decided upon with symptomatic treatment. The patient will be followed clinically and repeat MRI will be performed if clinical symptoms persist or worsen.
Our review of the literature found no prior cases of this entity.

Reference

Review of spinal pseudomeningoceles and cerebrospinal fluid fistulas.
Neurosurg Focus. 2000 Jul 15:9(1):e5. Review Hawk MW, Kim KD.

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