Disclosures: Sophie Jin: Nothing to disclose

Case Description: She presented with blood pressure of 180s/120s, proteinuria, neck pain, and headache, meeting criteria for pre-eclampsia with severe features. Following induction of labor with misoprostol, imaging revealed posterior fossa subarachnoid and intraventricular hemorrhage suspicious for ruptured aneurysm. Emergent cesarean section under general anesthesia delivered a healthy baby. Four hours later, she experienced acute paraplegia and left ankle clonus. Imaging demonstrated an intradural extramedullary hematoma spanning C7-T2 spinal levels, without visualized vascular abnormalities. She underwent hematoma evacuation, C7-T4 decompressive laminectomy and fusion, and was given steroids. Post-operatively, she remained paraplegic with neurogenic bladder. A week later, at our rehabilitation hospital, she was diagnosed with an L2 American Spinal Injury Association Impairment Scale (AIS) D incomplete paraplegic spinal cord injury; exam was significant for 4/5 strength in the bilateral lower limbs. After 11 days, she was discharged home, ambulating with modified independence using a rolling walker; her neurogenic bladder was managed with an indwelling urinary catheter.

Setting: Freestanding Inpatient Rehabilitation Hospital

Patient: 41-year-old 38-week pregnant woman with history of gestational hypertension, fetal growth restriction, 2 previous normal term births, no pre-term births or abortions (G3P2002).

Assessment/Results: Two months post injury, she still ambulates using the rolling walker and mastered self-catheterization. Repeat imaging showed total decompression of the spinal cord.

Discussion: Spinal subdural hematomas are rare occurrences with traumatic or nontraumatic etiologies. Traumatic etiologies include lumbar punctures, while nontraumatic etiologies include coagulopathy and arteriovenous malformations. Nontraumatic spinal subdural hematomas are slightly more common in women and associated with concomitant subarachnoid hemorrhage. Acute symptoms range from back pain, mild motor-sensory deficits to paraplegia, coma. Patients with major neurological defects warrant surgery. This is the first case to our knowledge that describes a non-traumatic spinal subdural hematoma following cesarean delivery.

Conclusion: Spinal subdural hematomas cause severe neurological deficits which may improve significantly with surgical intervention and comprehensive inpatient rehabilitation.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/postpartum-spinal-subdural-hematoma-resulting-in-paraplegia/