Spontaneous spinal subdural hematoma associated with intracranial idiopathic subarachnoid hemorrhage. A case report and review of the literature

•The association of spontaneous SSDH with intracranial idiopathic SAH is very rare, and its etiopathogeny has not yet been elucidated.•Surgical management is considered urgent when neurological deficits are present.•Spontaneous SSDH showing good recovery if clinico-radiological diagnosis is early, and evacuation surgery is performed on time. Spinal subdural hematoma (SSDH) is a rare disease of the spine. Cases that occur spontaneously in the absence of an identifiable etiology are considerably less common, concomitant spontaneous SSDH with intracranial subarachnoid hemorrhage (SAH) is even rarer. We present the unusual case of a 58-year-old woman developing spontaneous SSDH concomitant with idiopathic intracranial SAH. Our patient presented with severe sudden back pain followed by moderate headache, with rapid onset of thoracic radicular pain, paresthesia with paraparesis and urinary retention. MRI revealed a dorsal subdural hematoma at T8-T11 level spinal cord compression and idiopathic intracranial SAH. An urgent laminectomy with intradural exploration and evacuation of the hematoma were performed. MRA and surgery did not reveal any underlying pathology that could explain the origin of the bleeding. The patient showed substantial clinical improvement after two weeks of surgery with an intense rehabilitation program. SSDH, even if spontaneous, may be associated with risk factors requiring surgical treatment to minimize associated morbidity. This is the only case to report a combination of spontaneous SSDH and idiopathic intracranial SAH.