traumatic spinal subdural hematoma ( ssdh ) associated with intracranial subdural hematoma is a rare condition and usually associated with head injury . most ssdhs are caused by hematologic disease , anticoagulation therapy , lumbar puncture and epidural anesthesia . ssdh can compress the spinal cord or rootlets , which may result in motor weakness , neurogenic bladder , and neurogenic bowel . a 62-year - old man was admitted complained of lower back pain , radiating pain , and hypoesthesia in lower extremities , for 2 weeks . one month ago , he had slipped and been collided with head and back . on admission , he was alert without neurological deficit . brain computed tomography scan revealed isodense subdural hematoma in right hemisphere without midline shifting ( figure 1 ) . there is no evidence of vertebral fractures . spine magnetic resonance imaging ( mri ) revealed high signal intensity on t1-weighted image ( wi ) and low signal intensity on t2-wi in the l2 - 5 ( figure 2 ) . because of no neurological deficit and no prominent mass effect , the patient was treated conservatively . two weeks after admission , ssdh in the l2 - 5 was disappeared in follow - up lumbar mri ( figure 3 ) and his symptoms were relieved . ssdhs are uncommon condition and usually related with anticoagulation , lumbar puncture , and blood dyscrasia . traumatic ssdh is rarer than spontaneous ssdh . some traumatic ssdhs are associated with intracranial subdural hematoma . lower cerebrospinal fluid volume during and after surgery may predispose the tearing of the bridging veins.9 ) the symptom of ssdh is variable from mild back pain and radicular pain to paraplegia . hematomas are most likely venous in origin , which explains the relatively slow onset of symptom.10 ) if a patient with cranial subdural hematoma complains of back pain , radicular pain and weakness of extremities , then , spinal evaluation should be performed . although external dura is strong , the inner dura is weak and vulnerable to injury . ssdh may be related to redistribution of blood from the supratentorial subdural space to the most dependent areas due to gravity.1,6,8,9,16 ) blood moved caudally through the spinal subdural component is accumulated in the most dependent portion of the spine . in our case , intracranial subdural hematoma increased after the absorption of ssdh . ssdh appeared a few days after the spontaneous resolution of intracranial hematoma.1 ) another theory is that the pressure from cranial space may increase shearing force between spinal subdural and subarachnoid spaces , so the inner dura may tear and bleed.5 ) however , most of the intracranial hematomas are not concomitant with ssdh and the occurrence of ssdh is not necessarily proportional to the amount of intracranial hematoma . prompt diagnosis is important because early diagnosis with progressive neurological deficit before any irreversible changes is associated with a better outcome.5,13,15 ) mri is valuable for diagnosing the presence , location , degree of compression by hematoma , and extent of ssdh,2 ) and for follow - up . laminectomy and evacuation of hematoma may be one of the treatment methods.1,4,14 ) lumbar drainage is also an effective treatment method.3 ) surgery for ssdh should be indicated only for patients with moderate or severe paraparesis and sphincter disturbance.11,17 ) patients with paraplegia and sphincter disturbance have poor prognosis regardless of surgical or conservative management.12 ) conservative treatment plays a role in the treatment of ssdh with mild symptoms.5,12 ) in cases where the hematoma is extensive , conservative treatment may be an option.7 ) there is no spinal cord in lumbosacral region , so the patient with lumbosacral subdural hematoma and no neurological deficit can be readily treated conservatively.5 ) our patient was also treated conservatively and had a good prognosis . complete resolution of ssdh was confirmed by mri obtained 2 - 5 months later . in our case , ssdh was absorbed within a month from the trauma , which was more rapid than intracranial subdural hematoma . relatively small amount of blood may be influenced rapid resolution of hematoma than other cases or there may be an individual difference of velocity of hematoma dilution by cerebrospinal fluid . intracranial hematoma may grow larger after the absorption of ssdh because of the presence of bridging veins , normally presented cerebrospinal fluid in the intracranial subdural space , and delayed brain expansion . the traumatic ssdh associated with cranial subdural hematoma is a rare case . in case of ssdh
traumatic spinal subdural hematoma associated with intracranial subdural hematoma is a rare condition . 
 herein , we report the case of a 62-year - old man with lower back pain , radiating pain , and numbness in both lower extremities , without motor weakness , for 2 weeks . 
 lumbar magnetic resonance imaging ( mri ) revealed high signal intensity on t1-weighted image ( wi ) , and low signal intensity on t2-wi from l2 to l5 . 
 two weeks after conservative management , follow - up lumbar mri did not show the hematoma and his symptoms were relieved and there was no neurological deficit ; therefore , he was discharged . however , subsequently , intracranial subdural hematoma increased and upper extremity motor weakness appeared . 
 this was treated surgically . 
 if there is no neurological deficit , conservative treatment may be a good option . 
 follow - up evaluation for asymptomatic cranial subdural hematoma is necessary .