Concurrent spontaneous spinal and tentorial subdural hematomas in an older patient receiving anticoagulation treatment: a case report

Spinal subdural hematoma (SDH) is a rare condition with a wide range of clinical presentations. Its co-occurrence with intracranial SDH is even more uncommon. We report a case of a 70-year-old woman on chronic anticoagulation therapy who developed spontaneous spinal and tentorial SDH. She presented with bilateral buttock and posterior calf pain without neurological deficits. Imaging revealed lumbar spinal SDH and tentorial SDH. Conservative treatment was chosen due to the patient’s stable condition and the need to maintain anticoagulation. After switching from warfarin to low-molecular-weight heparin, her symptoms improved, and both hematomas nearly resolved. This case highlights that in older patients receiving anticoagulation therapy, atypical spinal pain may represent concurrent spinal and intracranial SDH. Careful individualized management of anticoagulation and vigilant monitoring facilitate favorable outcomes without surgical intervention.