Traumatic Cervical Spinal Subdural Hematoma and Peripheral Nerve Injury with Complete Right Upper Extremity Monoplegia: A Rare Case
DOI:
https://doi.org/10.21831/jomassh.v1i1.1153Keywords:
brachial plexus injury, Laminotomy, Neurological deficit, Subdural hematomaAbstract
Introduction: Cervical subdural hematoma (SDH) is a rare but life-threatening condition that can cause severe neurological deficits, including tetraparesis and brachial plexus injury (BPI). It is most often trauma-related and requires prompt diagnosis and surgical intervention to prevent permanent damage. This study presents a rare pediatric case and highlights the importance of early recognition and coordinated management to optimize neurological recovery. Case Presentation: A 16-year-old male presented with neck pain and right upper limb monoplegia following a high-speed motorcycle accident. Initial injuries included a temporoparietal laceration and multiple abrasions. MRI revealed a cervical SDH compressing the spinal cord at C5–C6, correlating with brachial plexus dysfunction. Surgical decompression via C5–C6 laminotomy and hematoma evacuation was performed within 48 hours. Postoperative recovery was supported by targeted neurorehabilitation and electrodiagnostic evaluation. Conclusion: This case emphasizes the critical role of early MRI-based diagnosis and timely laminotomy in managing traumatic cervical SDH, particularly in pediatric patients. Prompt surgical decompression significantly improves the chances of neurological recovery and functional restoration in cases complicated by brachial plexus injury.
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1. Alizadeh, A., Dyck, S. M., & Karimi-Abdolrezaee, S. (2019). Traumatic Spinal Cord Injury: An Overview of Pathophysiology, Models and Acute Injury Mechanisms. Frontiers in neurology, 10, 282. https://doi.org/10.3389/fneur.2019.00282
2. Bennett J, Das JM, Emmady PD. Spinal Cord Injuries. [Updated 2024 Dec 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560721/
3. Rettenmaier, L. A., Holland, M. T., & Abel, T. J. (2020). Acute, nontraumatic spontaneous spinal subdural hematoma: A case report and Systematic Review of the literature. Case Reports in Neurological Medicine, 2017, 1–12. https://doi.org/10.1155/2017/2431041
4. Yahanda, A. T., Connor, M. R., Desai, R., Giles, D. A., Gupta, V. P., Ray, W. Z., & Cadieux, M. (2023). Cervical spinal cord compression from subdural hematoma caused by traumatic nerve root avulsion: illustrative case. Journal of neurosurgery. Case lessons, 6(20), CASE23516. https://doi.org/10.3171/CASE23516
5. Gutkowska, O., Martynkiewicz, J., Urban, M., & Gosk, J. (2020). Brachial plexus injury after shoulder dislocation: a literature review. Neurosurgical review, 43(2), 407–423. https://doi.org/10.1007/s10143-018-1001-x
6. Luo TD, Levy ML, Li Z. Brachial Plexus Injuries. [Updated 2023 Feb 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482305/
7. Ramalho, B. L., Rangel, M. L., Schmaedeke, A. C., Erthal, F. S., & Vargas, C. D. (2021). Unilateral brachial plexus lesion impairs bilateral touch threshold. Frontiers in Neurology, 10. https://doi.org/10.3389/fneur.2019.00872
8. Wilson, K. V., McDonnell, J. M., O'Malley, S., Lynch, D., Larouche, J., Cunniffe, G. M., Darwish, S., Morris, S., & Butler, J. S. (2023). Morbidity and mortality of traumatic cervical spinal cord injuries in a geriatric cohort. Irish journal of medical science, 192(4), 1719–1725. https://doi.org/10.1007/s11845-022-03169-6
9. Kahraman, M. A., & Senturk, S. (2023). The Necessity of Extensive Decompression for Spinal Epidural Hematoma: A Case Report and Literature Review. Cureus, 15(8), e44192. https://doi.org/10.7759/cureus.44192
10. Maas, A. I. R., Menon, D. K., Manley, G. T., Abrams, M., Åkerlund, C., Andelic, N., Aries, M., Bashford, T., Bell, M. J., Bodien, Y. G., Brett, B. L., Büki, A., Chesnut, R. M., Citerio, G., Clark, D., Clasby, B., Cooper, D. J., Czeiter, E., Czosnyka, M., Dams-O'Connor, K., … InTBIR Participants and Investigators (2022). Traumatic brain injury: progress and challenges in prevention, clinical care, and research. The Lancet. Neurology, 21(11), 1004–1060. https://doi.org/10.1016/S1474-4422(22)00309-X
11. Girão, M. M. V., Miyahara, L. K., Dwan, V. S. Y., Baptista, E., Taneja, A. K., Gotfryd, A., & Castro, A. D. a. E. (2023). Imaging features of the postoperative spine: a guide to basic understanding of spine surgical procedures. Insights Into Imaging, 14(1). https://doi.org/10.1186/s13244-023-01447-0
12. Moriarty, H. K., O Cearbhaill, R., Moriarty, P. D., Stanley, E., Lawler, L. P., & Kavanagh, E. C. (2022). MR imaging of spinal haematoma: a pictorial review. The British journal of radiology, 92(1095), 20180532. https://doi.org/10.1259/bjr.20180532
13. Kahraman, M. A., & Senturk, S. (2023). The Necessity of Extensive Decompression for Spinal Epidural Hematoma: A Case Report and Literature Review. Cureus, 15(8), e44192. https://doi.org/10.7759/cureus.44192
14. Kissling, C., Häni, L., Schär, R. T., Goldberg, J., Raabe, A., & Jesse, C. M. (2024). Clinical outcome after surgical management of spontaneous spinal epidural hematoma. Acta Neurochirurgica, 166(1). https://doi.org/10.1007/s00701-024-06169-w
15. Estefan M, Munakomi S, Camino Willhuber GO. Laminectomy. [Updated 2023 Aug 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542274/
16. Foreman, M., Maddy, K., Patel, A., Reddy, A., Costello, M., & Lucke-Wold, B. (2023). Differentiating Lumbar Spinal Etiology from Peripheral Plexopathies. Biomedicines, 11(3), 756. https://doi.org/10.3390/biomedicines11030756
17. Antonovich D, Dua A. Electrodiagnostic Evaluation of Brachial Plexopathies. [Updated 2023 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562197/
18. Bateman, E. A., Larocerie-Salgado, J., Ross, D. C., Miller, T. A., & Pripotnev, S. (2023). Assessment, patient selection, and rehabilitation of nerve transfers. Frontiers in Rehabilitation Sciences, 4. https://doi.org/10.3389/fresc.2023.1267433
19. Li, H., Chen, J., Wang, J., Zhang, T., & Chen, Z. (2023). Review of rehabilitation protocols for brachial plexus injury. Frontiers in neurology, 14, 1084223. https://doi.org/10.3389/fneur.2023.1084223
20. Xiao, B., Zhao, L., Huang, Y., Ma, A., Pei, B., Li, Z., & Gu, F. (2023). Efficacy of Naprapathy in Brachial Plexus Injury: Protocol for a Randomized Clinical Trial. JMIR research protocols, 12, e46054. https://doi.org/10.2196/46054
21. Javeed, S., Greenberg, J. K., Zhang, J. K., Dibble, C. F., Khalifeh, J. M., Liu, Y., Wilson, T. J., Yang, L. J., Park, Y., & Ray, W. Z. (2022). Derivation and validation of a clinical prediction rule for upper limb functional outcomes after traumatic cervical spinal cord injury. JAMA Network Open, 5(12), e2247949. https://doi.org/10.1001/jamanetworkopen.2022.47949
22. Ter Wengel, P. V., De Witt Hamer, P. C., Pauptit, J. C., van der Gaag, N. A., Oner, F. C., & Vandertop, W. P. (2021). Early Surgical Decompression Improves Neurological Outcome after Complete Traumatic Cervical Spinal Cord Injury: A Meta-Analysis. Journal of neurotrauma, 36(6), 835–844. https://doi.org/10.1089/neu.2018.5974
23. Badhiwala, J. H., Wilson, J. R., Witiw, C. D., Harrop, J. S., Vaccaro, A. R., Aarabi, B., Grossman, R. G., Geisler, F. H., & Fehlings, M. G. (2020). The influence of timing of surgical decompression for acute spinal cord injury: a pooled analysis of individual patient data. The Lancet Neurology, 20(2), 117–126. https://doi.org/10.1016/s1474-4422(20)30406-3
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