Spinal Cord Hemorrhage Clinical Presentation

  • Author: Richard M Zweifler, MD; Chief Editor: Helmi L Lutsep, MD   more...
 
Updated: Jul 19, 2010
 

History

  • Intramedullary hemorrhage
    • Sudden, severe, localized back pain with or without radicular pain
    • Hemiparesis, paraparesis, or quadriparesis
    • Sensory loss below the lesion
    • Loss of sphincter control
  • Spinal subarachnoid hemorrhage
    • Sudden, severe, localized back pain with or without radicular pain
    • Headache
    • Meningismus
  • Spinal epidural hemorrhage and spinal subdural hemorrhage
    • Sudden, severe, localized back pain with or without radicular pain
    • Hemiparesis, paraparesis, or quadriparesis
    • Sensory loss below lesion
    • Loss of sphincter control
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Physical

  • Intramedullary hemorrhage - Myelopathy (eg, Brown-Séquard syndrome, central cord syndrome, transection syndrome, conus medullaris syndrome) with or without radiculopathy
  • Spinal subarachnoid hemorrhage
    • Myelopathy (eg, Brown-Séquard syndrome, transection syndrome, conus medullaris syndrome, cauda equina syndrome) with or without radiculopathy
    • Cranial neuropathies
    • Papilledema
    • May have cutaneous angioma or bruit over the spine
  • Spinal epidural hemorrhage and spinal subdural hemorrhage - Myelopathy (eg, Brown-Séquard syndrome, transection syndrome, conus medullaris syndrome, cauda equina syndrome) with or without radiculopathy
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Causes

  • Intramedullary hemorrhage
    • Trauma
    • Vascular malformations
    • Bleeding diatheses
    • Anticoagulants
    • Hemorrhage into tumor
    • Venous infarction
  • Spinal subarachnoid hemorrhage
    • Spinal angioma
    • Spinal artery aneurysm
    • Intracranial aneurysm
    • Bleeding diatheses
    • Anticoagulants
    • Polyarteritis nodosa
    • Hemorrhage into tumor
    • Trauma
    • Lumbar puncture
  • Spinal epidural hemorrhage
    • Spontaneous
    • Trauma
    • Liver disease with portal hypertension
    • Bleeding diatheses
    • Lumbar puncture
    • Epidural anesthesia
    • Epidural vascular malformation
  • Spinal subdural hemorrhage
    • Bleeding diatheses
    • Anticoagulants
    • Trauma
    • Lumbar puncture
    • Vascular malformations
    • Spinal surgery
    • Spontaneous
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Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Richard M Zweifler, MD  Chief of Neurology, Sentara Healthcare, Norfolk, VA; Professor of Neurology, Eastern Virginia Medical School, Norfolk, VA

Richard M Zweifler, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, American Medical Association, American Stroke Association, Royal Society of Medicine, and Stroke Council of the American Heart Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Rodrigo O Kuljis, MD  Esther Lichtenstein Professor of Psychiatry and Neurology, Director, Division of Cognitive and Behavioral Neurology, Department of Neurology, University of Miami School of Medicine

Rodrigo O Kuljis, MD is a member of the following medical societies: American Academy of Neurology and Society for Neuroscience

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Howard S Kirshner, MD  Professor of Neurology, Psychiatry and Hearing and Speech Sciences, Vice Chairman, Department of Neurology, Vanderbilt University School of Medicine; Director, Vanderbilt Stroke Center; Program Director, Stroke Service, Vanderbilt Stallworth Rehabilitation Hospital; Consulting Staff, Department of Neurology, Nashville Veterans Affairs Medical Center

Howard S Kirshner, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Heart Association, American Medical Association, American Neurological Association, American Society of Neurorehabilitation, National Stroke Association, Phi Beta Kappa, and Tennessee Medical Association

Disclosure: Nothing to disclose.

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Chief Editor

Helmi L Lutsep, MD  Professor, Department of Neurology, Oregon Health and Science University School of Medicine; Associate Director, Oregon Stroke Center

Helmi L Lutsep, MD is a member of the following medical societies: American Academy of Neurology and American Stroke Association

Disclosure: Co-Axia Consulting fee Review panel membership; AGA Medical Consulting fee Review panel membership; Concentric Medical Consulting fee Review panel membership

References

  1. Kreppel D, Antoniadis G, Seeling W. Spinal hematoma: a literature survey with meta-analysis of 613 patients. Neurosurg Rev. 2003;26:1-49.

  2. Groen RJM. Non-operative treatment of spontaneous spinal epidural hematomas: a review of the literature and a comparison with operative cases. Acta Neurochir (Wien). 2004;146:103-110.

  3. Aminoff MJ. Vascular disorders of the spinal cord. In: Davidoff RA, ed. Handbook of the Spinal Cord. New York: Marcel Dekker; 1987:259-97.

  4. Barth A, Bougousslavsky J, Caplan LR. Spinal stroke syndromes. In: Barth A, Caplan LR, eds. Stroke Syndromes. 1995. New York: Cambridge University; 395-402.

  5. Geldmacher DS, Bowen BC. Spinal cord vascular disease. In: Bradley WG, Daroff RB, Fenichel GM, Marsden CD, eds. Neurology in Clinical Practice Principles of Diagnosis and Management. 4th ed. Philadelphia, Pa: Butterworth-Heimann; 2004:1313-22.

  6. Karavelis A, Foroglou G, Petsanas A, Zarampoukas T. Spinal cord dysfunction caused by non-traumatic hematomyelia. Spinal Cord. May 1996;34(5):268-71. [Medline].

  7. Russell NA, Benoit BG. Spinal subdural hematoma. A review. Surg Neurol. Aug 1983;20(2):133-7. [Medline].

  8. Toole JF. Spinal cord vascular anatomy and diseases. In: Toole JF, ed. Cerebrovascular Disorders. 4th ed. Baltimore, Md: Lippincott Williams & Wilkins; 1990:519-34.

  9. Weisberg LA. Vascular diseases of the spinal cord. In: Rowland LP, ed. Merritt's Textbook of Neurology. 10th ed. Baltimore, Md: Lippincott Williams & Wilkins; 2001:271.

 
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T2-weighted sagittal MRI of the cervical spine shows mixed signal intensity within the spinal cord consistent with posttraumatic intramedullary hemorrhage. The hypointensity reflects deoxyhemoglobin and the hyperintensity reflects either early hemorrhage or edema. The C6 vertebral body is distracted from C7 with extensive ligamentous injury. Courtesy of Francis G. Greiner, MD, Department of Radiology, University of South Alabama College of Medicine.
 
 
 
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