Spinal Subdural Hematoma With Paraplegia Mimicking Dorsolumbar Prolapsed Disc: A Case Report

Spinal Subdural Hematoma (SSH) is a rare condition with an unknown incidence in the general population. Iatrogenic spinal subdural hematoma radiologically mimicking a prolapsed dorsolumbar disc has not been published in the literature.

A 65-year-old female presented with altered sensorium and generalized weakness for 3 days evaluated by a neurologist who diagnosed it as a metabolic encephalopathy with Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) with severe anemia and hypothyroidism. She underwent a diagnostic lumbar puncture and following which, within 24 hours, she developed weakness of both the lower limbs. MRI of dorsolumbar spine was done which revealed D12-L1 extruded disc causing severe compression to the conus medullaris with D12-L2 subarachnoid lesion and cord edema. On opening the dura, a large organized hematoma on the anterior aspect of the conus was seen and evacuated.

Spinal subdural hematoma presents with a spectrum of signs and symptoms. Although MRI is the investigation of choice but SSH presenting like a prolapsed intervertebral disc on MRI is one of its kinds and should be kept in mind since it carries a grave prognosis if not treated early with emergency decompression.