Spontaneous Spinal Subarachnoid Hemorrhage: Presentation and Outcome

Background: Spontaneous spinal subarachnoid hemorrhage (SSAH) is a rare but serious condition that can lead to a variety of medical complications. Methods: Using the Mayo Clinic Rochester database, consecutive patients admitted to the Mayo Clinic Rochester, Minnesota hospital with spontaneous SSAH (not iatrogenic or traumatic) between January 2000 and December 2015 were retrospectively reviewed. Demographic and clinical data and functional outcomes as categorized by the modified Rankin Scale (mRS) score at the time of discharge and at postadmission follow-up were assessed. Results: Eight patients (median age 70 years, range 51-87) were identified. Seven patients presented with acute back pain or headache. Seven patients had poorly controlled chronic hypertension. Two patients had vasculitis and 1 had an arteriovenous malformation. Complications included cord compression (n = 4), hyponatremia (n = 5), sulcal subarachnoid hemorrhage (n = 2), chronic arachnoiditis (n = 1), vasospasm (n = 1), ischemic infarct (n = 1), and late cord ischemia (n = 1). All patients were managed medically including blood pressure control and repeat imaging. One patient had an aneurysm, which was embolized, and 2 received steroids for vasculitis. One patient died during hospitalization and 1 died within a week of discharge. Five patients had improved and 1 had unchanged mRS score at posthospitalization follow-up. Conclusions: SSAH should be considered in patients with sudden onset of severe back pain and headache, especially if as associated with lower extremity weakness or urinary retention. Our findings suggest that older patients with poorly controlled hypertension are at particular risk for spontaneous SSAH. In our study vascular anomalies were found in 25% of patients, vasculitis in 25%, hyponatremia in 63%, and cord compression in 50%. Cord compression may be managed conservatively. Mortality was 25% in the 3 months following the initial event, primarily due to other medical comorbidities.