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Background <p>HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) represents a severe variant of preeclampsia, typically associated with cerebral complications. While posterior reversible encephalopathy syndrome (PRES) and intracranial hemorrhage are well-documented neurological manifestations, spontaneous idiopathic spinal subarachnoid hemorrhage (SAH) is exceedingly rare.</p> Case Presentation <p>We present a case of a 37-year-old primigravida with dichorionic diamniotic twins who presented at 27&#xa0;weeks of gestation with HELLP syndrome and sudden onset bilateral lower limb paralysis, complete sensory loss, and bowel and bladder incontinence suggestive of cauda equina syndrome. Magnetic resonance imaging demonstrated extensive spinal subarachnoid hemorrhage extending from T10 to S1 with cauda equina nerve root compression. Common etiologies of spinal SAH including trauma, vascular malformations, and iatrogenic causes were excluded. Following emergency cesarean delivery, the patient underwent L1-L2 laminectomy with subarachnoid hematoma evacuation, resulting in significant neurological improvement at six week follow-up.</p> Conclusion <p>This case highlights idiopathic spinal SAH as an extremely rare but potentially devastating neurological complication of HELLP syndrome. To the best of our knowledge, this is the only second such case reported in the literature. Early recognition and prompt multidisciplinary intervention are crucial for favorable outcomes in this rare entity with otherwise poor prognosis.</p>

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Spontaneous Idiopathic Spinal Subarachnoid Hemorrhage as a Rare Neurological Complication of HELLP Syndrome: A Case Report

  • 期刊论文

  • 发表日期：

    2026年7月27日

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  • Nikita Sharma,
  • Seema Sheokand,
  • Ajay Choudhary

摘要

Background

HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) represents a severe variant of preeclampsia, typically associated with cerebral complications. While posterior reversible encephalopathy syndrome (PRES) and intracranial hemorrhage are well-documented neurological manifestations, spontaneous idiopathic spinal subarachnoid hemorrhage (SAH) is exceedingly rare.

Case Presentation

We present a case of a 37-year-old primigravida with dichorionic diamniotic twins who presented at 27 weeks of gestation with HELLP syndrome and sudden onset bilateral lower limb paralysis, complete sensory loss, and bowel and bladder incontinence suggestive of cauda equina syndrome. Magnetic resonance imaging demonstrated extensive spinal subarachnoid hemorrhage extending from T10 to S1 with cauda equina nerve root compression. Common etiologies of spinal SAH including trauma, vascular malformations, and iatrogenic causes were excluded. Following emergency cesarean delivery, the patient underwent L1-L2 laminectomy with subarachnoid hematoma evacuation, resulting in significant neurological improvement at six week follow-up.

Conclusion

This case highlights idiopathic spinal SAH as an extremely rare but potentially devastating neurological complication of HELLP syndrome. To the best of our knowledge, this is the only second such case reported in the literature. Early recognition and prompt multidisciplinary intervention are crucial for favorable outcomes in this rare entity with otherwise poor prognosis.