# Traumatic Isolated Lumbosacral Spinal Subdural Hematoma in a Pediatric Patient: A Case Report and Literature Review

## TL;DR

A 16-year-old girl developed a rare spinal subdural hematoma after a trauma, which was successfully treated without surgery.

## Contribution

First reported case of isolated lumbosacral sSDH in a female pediatric patient managed conservatively.

## Key findings

- MRI showed a subdural fluid collection with the 'inverted Mercedes-Benz' sign, confirming sSDH.
- Conservative management with steroids led to complete symptom resolution and hematoma resolution.
- Literature review identified six prior pediatric cases, most of which required surgical intervention.

## Abstract

Spinal subdural hematomas (sSDHs) are rare, particularly in the pediatric population and in the context of trauma without coexisting intracranial pathology. The pathophysiology of isolated sSDH is poorly understood, given the paucity of vasculature in the spinal subdural space. We present the case of a 16-year-old female who developed progressive lower back pain and difficulty with ambulation one week following traumatic ejection from a golf cart. Initial evaluation, including whole-body CT, revealed no abnormalities. One week after the initial trauma, the patient presented with back pain, limiting ambulation without focal deficits or signs of cauda equina syndrome. Magnetic resonance imaging demonstrated a subdural fluid collection from L1-S2 spinal levels and “inverted Mercedes-Benz” sign consistent with sSDH. The patient was managed conservatively with steroids and close observation. At her three-month follow-up, the patient had complete symptom resolution, and MRI/MRA demonstrated interval resolution of sSDH and no evidence of vascular malformations. A review of the literature identified six previous cases of traumatic isolated sSDH in pediatric patients. The majority presented with neurological deficits and were managed surgically. Our case represents the first reported instance of an isolated lumbosacral sSDH in a female pediatric patient managed successfully with conservative management. Isolated sSDH is exceedingly rare, particularly in the context of pediatric trauma, and may have a delayed presentation with no focal neurological deficits. MRI imaging is essential for diagnosis, and characteristic signs, such as the “inverted Mercedes-Benz” sign, may aid diagnosis. Conservative management may be an effective strategy in select cases of sSDH, such as those with stable, improving, or non-focal symptoms and no signs of hematoma expansion on imaging, highlighting the importance of individualized management strategies.