• Takaaki Uto, Noritaka Yonezawa, Nobuhiko Komine, Yuji Tokuumi, Keiichiro Torigoe, Yukihiko Koda, and Hiroyuki Tsuchiya.
• Department of Orthopaedics.
• Medicine (Baltimore). 2018 Sep 1; 97 (38): e12479.

RationaleA spinal subdural hematoma (SDH) is rarely complicated with an intracranial SDH. We found only 7 cases of spontaneous concurrent lumbar spinal and cranial SDHs, in which lumbar symptoms occurred before head symptoms.Patient ConcernsWe describe a 77-year-old man with spontaneous concurrent spinal and cranial SDHs, in whom the spinal SDH was identified 30 days before the intracranial chronic SDH.DiagnosisMagnetic resonance imaging showed a spinal SDH at L4/L5. There was no paralysis, and the patient was managed conservatively. About 30 days after the onset of back pain, he experienced tinnitus and visual hallucination. Brain computed tomography showed a chronic SDH and midline shift.InterventionsBurr-hole evacuation was performed, and the patient's condition improved.OutcomesAt 5 months of follow-up, there was no recurrence of the spinal or intracranial SDH.LessonsIt is important to consider the possibility of intracranial hemorrhage when a spinal SDH is identified.

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