Surgical Management of Concurrent Cranial and Spinal Subdural Hematomas Causing Confusion and Lower-Extremity Weakness: A Case Report and Literature Review.

BACKGROUND Simultaneous cranial and spinal subdural hematomas are rare. When cranial (CSDH) and spinal subdural hematomas (SSDH) are identified concurrently, optimal management depends on hematoma size, chronicity, degree of compression or shift, and the patient's neurologic status. Proposed etiologies include dual insult versus craniocaudal migration. Here, we report the case of a 40-year-old man presenting with confusion and lower-extremity weakness due to concurrent intracranial and spinal subdural hematomas. This report aims to demonstrate the safety and feasibility of tandem surgical intervention for concomitant CSDH and SSDH. CASE REPORT A 40-year-old man presented with 1 week of progressive low back pain, bilateral radiculopathy, weakness, and urinary symptoms. Imaging revealed concurrent chronic cranial and spinal SDH. At initial evaluation, the patient was agitated and combative, unable to grasp the scope of his clinical situation; he declined surgical intervention and left the hospital. He returned the following day after a ground-level fall. After further counseling, he underwent craniotomy and multilevel laminectomy with intradural exploration for evacuation of both hemorrhages within 72 h of initial presentation and admission to the intensive care unit. CONCLUSIONS Concurrent cranial and spinal subdural hematomas are rare but clinically significant, and both lesions may be symptomatic and require intervention. Acute surgical management of simultaneously diagnosed CSDH and SSDH is infrequently reported, with most cases attributed to either dual insult or craniocaudal migration. This case report demonstrates the safety and feasibility of early, relatively aggressive surgical intervention when both lesions meet the criteria for urgent evacuation.