Abstract
RATIONALE: The co-occurrence of chronic subdural hematoma (CSDH) and spinal subdural hematoma (SSDH) is exceptionally rare, with ambiguous pathogenesis complicating management. This case aims to enhance understanding of its clinical trajectory, particularly the risk of intracranial progression after spinal surgery, which is critical for optimizing patient outcomes. PATIENT CONCERNS: A 45-year-old woman presented with 3 days of severe lumbocrural pain and a 3-week history of headache after head trauma. She also reported 5 days of bowel dysfunction. DIAGNOSES: Lumbar magnetic resonance imaging revealed a lumbosacral SSDH (L2-S1). Cranial magnetic resonance imaging showed a right CSDH. Both hematomas were T1-isointense and T2-hyperintense without significant midline shift initially. INTERVENTIONS: Oral atorvastatin (40 mg/day) was initiated for the CSDH. Emergency L4 hemilaminectomy for SSDH evacuation was performed due to intolerable pain and bowel dysfunction. On postoperative day 2, cranial CT showed CSDH progression with increased midline shift, prompting emergency burr-hole drainage. OUTCOMES: Lumbocrural pain resolved immediately postspinal surgery (visual analog scale: 9 to 2). Headache improved significantly postcranial drainage (numerical rating scale: 8 to 3). Bowel function normalized by discharge. LESSONS: This case highlights that: SSDH can present with bowel dysfunction, a novel finding; postoperative intracranial hematoma progression is a real risk, necessitating vigilant neuroimaging surveillance after spinal evacuation; and the symptom sequence (cephalalgia preceding lumbalgia) supports the hematoma migration theory.