Concomitant Intracranial and Lumbar Chronic Subdural Hematoma Treated by Fluoroscopic Guided Lumbar Puncture: A Case Report and Literature Review

Neurol Med Chir (Tokyo). 2018 Apr 15;58(4):178-184. doi: 10.2176/ Epub 2018 Feb 23.


A 40-year-old man presented with a severe headache, lower back pain, and lower abdominal pain 1 month after a head injury caused by falling. Computed tomography (CT) of the head demonstrated bilateral chronic subdural hematoma (CSDH) with a significant amount in the left frontoparietal region. At the same time, magnetic resonance imaging (MRI) of the lumbar spine also revealed CSDH from L2 to S1 level. A simple drainage for the intracranial CSDH on the left side was performed. Postoperatively, the headache was improved; however, the lower back and abdominal pain persisted. Aspiration of the liquefied spinal subdural hematoma was performed by a lumbar puncture under fluoroscopic guidance. The clinical symptoms were dramatically improved postoperatively. Concomitant intracranial and spinal CSDH is considerably rare so only 23 cases including the present case have been reported in the literature so far. The etiology and therapeutic strategy were discussed with a review of the literature. Therapeutic strategy is not established for these two concomitant lesions. Conservative follow-up was chosen for 14 cases, resulting in a favorable clinical outcome. Although surgical evacuation of lumbosacral CSDH was performed in seven cases, an alteration of cerebrospinal fluid (CSF) pressure following spinal surgery should be reminded because of the intracranial lesion. Since CSDH is well liquefied in both intracranial and spinal lesion, a less invasive approach is recommended not only for an intracranial lesion but also for spinal lesion. Fluoroscopic-guided lumbar puncture for lumbosacral CSDH following burr hole surgery for intracranial CSDH could be a recommended strategy.

Keywords: chronic subdural hematoma; low back pain; spinal puncture; spinal subdural hematoma.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Chronic Disease
  • Fluoroscopy
  • Hematoma, Subdural, Intracranial / complications*
  • Hematoma, Subdural, Intracranial / diagnostic imaging
  • Hematoma, Subdural, Intracranial / surgery*
  • Hematoma, Subdural, Spinal / complications*
  • Hematoma, Subdural, Spinal / diagnostic imaging
  • Hematoma, Subdural, Spinal / surgery*
  • Humans
  • Lumbar Vertebrae*
  • Magnetic Resonance Imaging
  • Male
  • Spinal Puncture*
  • Tomography, X-Ray Computed