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Spinal Cord Hemorrhage Clinical Presentation

  • Author: Richard M Zweifler, MD; Chief Editor: Helmi L Lutsep, MD  more...
 
Updated: Mar 11, 2014
 

History

See the list below:

  • 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

See the list below:

  • 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

See the list below:

  • Intramedullary hemorrhage
    • Trauma
    • Vascular malformations
    • Bleeding diatheses
    • Anticoagulants
    • Hemorrhage into tumor
    • Venous infarction
    • Spinal radiation
    • Gower's intrasyringal hemorrhage
  • 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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Contributor Information and Disclosures
Author

Richard M Zweifler, MD Chief of Neurosciences, Sentara Healthcare; Professor and Chair of Neurology, Eastern Virginia Medical School

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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 Neurological Association, American Society of Neurorehabilitation, American Academy of Neurology, American Heart Association, American Medical Association, National Stroke Association, Phi Beta Kappa, Tennessee Medical Association

Disclosure: Nothing to disclose.

Chief Editor

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

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

Disclosure: Medscape Neurology Editorial Advisory Board for: Stroke Adjudication Committee, CREST2.

Additional Contributors

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, Society for Neuroscience

Disclosure: Nothing to disclose.

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

  2. Borm W, Mohr K, Hassepass V et al. Spinal hematoma unrelated to previous srugery. Analysis of 15 consecutive cases treated in a single institution within a 10-year period. Spine. 2004. 29:E555-E561.

  3. Byrne TN, Benzel EC, Waxman SG. Diseases of the Spine and Spinal Cord. New York: Oxford University Press; 2000. Contemporary Neurology Series:

  4. Domenicucci M, Ramieri A, Paolini S, et al. Spinal subarachnoid hematomas: our experience and literature review. Acta Neurochir (Wien). 2005 Jul. 147(7):741-50; discussion 750. [Medline].

  5. Geibprasert S, Krings T, Apitzsch J, et al. Subarachnoid hemorrhage following posterior spinal artery aneurysm. A case report and review of the literature. Interv Neuroradiol. 2010 Jun. 16(2):183-90. [Medline].

  6. Geldmacher DS, Bowen BC. Spinal cord vascular disease. Bradley WG, Daroff RB, Fenichel GM, Jankovic J, eds. Neurology in Clinical Practice Principles of Diagnosis and Management. 5th ed. Philadelphia, Pa: Butterworth-Heimann; 2008. 1285-93.

  7. 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.

  8. Gross BA, Du R, Popp AJ, Day AL. Intramedullary spinal cord cavernous malformations. Neurosurg Focus. 2010 Sep. 29(3):E14. [Medline].

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

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

  11. Leep Hunderfund AN, Wijdicks EF. Intramedullary spinal cord hemorrhage (hematomyelia). Rev Neurol Dis. 2009 Spring. 6(2):E54-61. [Medline].

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

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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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