eMedicine Specialties > Neurology > Neurological Emergencies

Spinal Cord Hemorrhage: Follow-up

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

Updated: Dec 4, 2008

Follow-up

Further Inpatient Care

Once the patient with spinal cord hemorrhage has been treated, whether medically, via interventional radiology, or surgery, rehabilitation can begin. Usually this is accomplished in an inpatient rehabilitation setting.

Further Outpatient Care

After the patient is discharged from inpatient care, outpatient therapies continue. Medical treatments are frequently necessary for the late complications of spinal cord hemorrhage, especially spasticity, pain, and neurogenic bladder.

Inpatient & Outpatient Medications

  • Spasticity secondary to spinal cord hemorrhage is treated in similar ways to spasticity secondary to spinal cord injury or multiple sclerosis. Drugs include baclofen, tizanidine, and diazepam.
  • Pain following spinal cord hemorrhage, other than pain directly secondary to spasticity, is treated similarly to neuropathic pain syndromes such as those in multiple sclerosis. Drugs include gabapentin, amitriptyline, and carbamazepine.
  • Bladder complications of spinal cord hemorrhage are similar to those of spinal cord injury or multiple sclerosis. Consultation with a urologist may be necessary. Drug therapy with anticholinergic agents may be beneficial for reflex uninhibited bladder (ie, failure to store), and intermittent self-catheterization is essential in patients with inability to void (ie, failure to empty).

Deterrence/Prevention

Avoid lumbar puncture in patients with hematologic disorders or in those treated with prescribed anticoagulants.

Prognosis

Prognosis varies but generally is correlated with severity of deficit. A more favorable outcome is seen in patients receiving prompt diagnosis and surgical intervention.

Miscellaneous

Medicolegal Pitfalls

  • Delays in diagnosis and/or surgical intervention
  • Failing to correct treatable coagulopathies
 


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
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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.

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Further Reading

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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

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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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