Comprehensive Evaluation of Diagnostic and Treatment Strategies for Idiopathic Spinal Subarachnoid Hemorrhage

Background: Idiopathic spinal subarachnoid hemorrhage (IS-SAH), defined as spinal SAH without apparent cause, is extremely rare. The objective of the present study was to establish a consensus on the diagnosis and management of IS-SAH. Methods: We enrolled 5 consecutive cases of IS-SAH at our institution, and we enrolled 19 previously published cases as a literature review. The patient presentations, diagnostic test findings, treatment strategies, and outcomes were retrospectively assessed. Possible causes of spinal SAH were basically excluded by multimodalities, including brain and spinal digital subtraction angiographies. Results: IS-SAH usually developed in middle-aged people around 55 years old and typically presented with acute migrating back pain. Lumbar puncture and spinal magnetic resonance imaging demonstrated xanthochromia or an abnormal intensity area around the spine in all study patients who underwent these diagnostic tests. All of the patients from our institution were discharged with 1 patient (20%) complaining of neurologic dysfunction at discharge, and 1 patient (5.3%) in the published cases died during hospitalization and 5 (26.3%) complained of neurologic dysfunction at discharge. In addition, the surgical findings in 1 case from our institution suggested that one of the mechanisms of IS-SAH is a bleeding from a microvessel around the spine, and we newly propose spinal drainage as one of the treatment options in patients with IS-SAH based on our experience. Conclusions: We summarized our experience of 5 cases of IS-SAH with a literature review. We demonstrated that spinal drainage could be one of the treatment options in patients with IS-SAH.