eMedicine Specialties > Neurology > Neurological Emergencies

Spinal Cord Hemorrhage: Differential Diagnoses & Workup

Author: Richard M Zweifler, MD, Chief of Neurology, Sentara Healthcare, Norfolk, VA
Contributor Information and Disclosures

Updated: Dec 4, 2008

Differential Diagnoses

Arteriovenous Malformations
Polyarteritis Nodosa
Blood Dyscrasias and Stroke
Spinal Cord Infarction
Cauda Equina and Conus Medullaris Syndromes
Spinal Epidural Abscess
Cerebral Aneurysms
Subarachnoid Hemorrhage
Ependymoma
Subdural Hematoma
Epidural Hematoma
Syringomyelia
Lumbar Puncture (CSF Examination)

Other Problems to Be Considered

Spinal injury
Spinal cord tumors
Cervical disk syndromes
Lumbosacral disk syndromes
Posttraumatic pain syndromes
Back pain

Workup

Laboratory Studies

  • CBC count with platelets
  • Prothrombin time/activated partial thromboplastin time - To exclude coagulopathy

Imaging Studies

  • Spinal MRI
    • Preferred test to confirm presence and delineate location of hemorrhage (see Media file 1)
    • May indicate underlying pathology
  • CT myelography - Use when MRI is unavailable or if patient cannot tolerate MRI

Procedures

  • Lumbar puncture: Cerebrospinal fluid (CSF) is usually bloody or xanthochromic and protein content is increased.
  • Spinal angiography: Selective spinal angiography may be helpful in delineating the size, location, configuration, and blood flow of a malformation.

More on Spinal Cord Hemorrhage

Overview: Spinal Cord Hemorrhage
Differential Diagnoses & Workup: Spinal Cord Hemorrhage
Treatment & Medication: Spinal Cord Hemorrhage
Follow-up: Spinal Cord Hemorrhage
Multimedia: Spinal Cord Hemorrhage
References

References

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

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

  3. 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.

  4. 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].

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

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

  7. 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.

Further Reading

Keywords

spinal cord hemorrhage, hematomyelia, spinal subarachnoid hemorrhage, SAH, spinal epidural hemorrhage, EDH, subdural hemorrhage, SDH, subarachnoid space, bleeding in the spinal cord, intramedullary hemorrhage, spinal angioma

Contributor Information and Disclosures

Author

Richard M Zweifler, MD, Chief of Neurology, Sentara Healthcare, 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.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

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: Boehringer Ingelheim Honoraria Speaking and teaching; BMS/Sanofi Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching; Novartis Consulting fee Review panel membership

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
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: Nothing to disclose.

Chief Editor

Helmi L Lutsep, MD, Professor, Department of Neurology, Oregon Health and Science University; 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; Talecris Consulting fee Review panel membership; AGA Medical Consulting fee Review panel membership; Boehringer Ingelheim Honoraria Speaking and teaching; Boston Scientific Honoraria Speaking and teaching; Concentric Medical None Review panel membership; Northstar Neuroscience  Review panel membership; ev3 Consulting fee Review panel membership

 
 
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