Predictors of Outcome in Nontraumatic Spontaneous Acute Spinal Subdural Hematoma: Case Report and Literature Review

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• 作者：Benedito Jamilson A. Pereira¹ ; ³ ; Antô ; nio Nogueira de Almeida² ; ³ ; ^{antonio.almeida@hc.fm.usp.br" class="auth_mail" title="E-mail the corresponding author} ; Valé ; ria Marques F. Muio³ ; Jean G. de Oliveira¹ ; ³ ; Carlos Vanderlei Medeiros de Holanda¹ ; ³ ; Nair Clé ; a Fonseca³
• 关键词：Blood coagulation disorder ; Hematoma ; Spinal cord compression ; Spinal subdural ; Surgery
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：89
• 期：Complete
• 页码：574-577.e7
• 全文大小：2108 K

文摘

To analyze the clinical presentation and outcome of nontraumatic spontaneous acute spinal subdural hematoma by observing the predictors of outcome.

Methods/Results

This study was based on a case report and systematic review of the international literature. Among the 151 patients, 80 were female and 65 were male (1.25 female/1.0 male). The age distribution ranged from 6 months to 87 years, with a small increase in incidence between the first and second decade of life and a major peak at age 60 years. The difference of proportion of good results between patients with and without established neurologic deficits was: 0.488, 95% confidence interval (95% CI) 0.237–0.648, P = 2.71e-08; coagulopathy was 0.335, 95% CI 0.163–0.508, P = 0.0002; SAH was 0.0539, 95% CI −0.119 to 0.226, P = 0.6529; lumbar puncture/associated diseases was 0.149 95% CI −0.032 to 0.330, P = 0.1171; surgery was 0.0593, 95% CI −0.114 to 0.233, P = 0.5838; and hematoma extension equal or longer than 5 levels was 0.010 95% CI −0.178 to 0.197, P = 1.

Conclusions

Although mortality and morbidity associated with nontraumatic spontaneous acute spinal subdural hematoma has decreased during the last 2 decades, the disease still carries a mortality rate of approximately1.3% and a morbidity (permanent neurologic deficits) rate of 28%. The main factors affecting the outcome are neurologic status at presentation and coagulopathies.