Spinal Cord Hemorrhage

Author: Richard M Zweifler, MD; Chief Editor: Helmi L Lutsep, MD more...

Updated: Jul 19, 2010

What would you like to print?

Background
Pathophysiology
Epidemiology
Show All

Background

Hemorrhage affecting the spinal cord is rare. It most commonly is caused by trauma, vascular malformations, or bleeding diatheses and can be intramedullary, subarachnoid, subdural, or epidural. Onset is usually sudden and painful, causing myelopathic signs and symptoms.

Pathophysiology

Hematomyelia is caused by bleeding within the substance of the spinal cord. The blood tends to dissect longitudinally above and below the hemorrhage, disrupting gray matter more than white matter. Spinal subarachnoid hemorrhage (SAH) may cause symptoms due to blood in the subarachnoid space or blood dissecting into the spinal cord or along nerve root sheaths. Spinal epidural hemorrhage (EDH) and subdural hemorrhage (SDH) cause compressive symptoms due to hematomas in these spaces.

Frequency

United States

Hemorrhage affecting the spinal cord is rare. Spinal subarachnoid hemorrhage accounts for less than 1% of all subarachnoid hemorrhages. Spinal epidural hemorrhage occurs at least 4 times more commonly than spinal subdural hemorrhage.

Mortality/Morbidity

Spinal hemorrhage can lead to irreversible myelopathy (including conus medullaris and cauda equina syndromes) and/or radiculopathy.

Sex

The incidence of hematomyelia, spinal subarachnoid hemorrhage, and spinal epidural hemorrhage is higher in males than in females. Spinal subdural hemorrhage is more common in women (female-to-male ratio is 2:1).^[1]

Age

Spinal epidural hemorrhage has a bimodal distribution, with peaks during childhood and the fifth and sixth decades of life. Spinal epidural hemorrhage is most common in the cervical region in children and in the thoracic and lumbar regions in adults. Spinal subdural hemorrhage predominates in the sixth decade.^[1]

Proceed to Clinical Presentation

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

Kreppel D, Antoniadis G, Seeling W. Spinal hematoma: a literature survey with meta-analysis of 613 patients. Neurosurg Rev. 2003;26:1-49.
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.
Aminoff MJ. Vascular disorders of the spinal cord. In: Davidoff RA, ed. Handbook of the Spinal Cord. New York: Marcel Dekker; 1987:259-97.
Barth A, Bougousslavsky J, Caplan LR. Spinal stroke syndromes. In: Barth A, Caplan LR, eds. Stroke Syndromes. 1995. New York: Cambridge University; 395-402.
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. 4^th ed. Philadelphia, Pa: Butterworth-Heimann; 2004:1313-22.
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].
Russell NA, Benoit BG. Spinal subdural hematoma. A review. Surg Neurol. Aug 1983;20(2):133-7. [Medline].
Toole JF. Spinal cord vascular anatomy and diseases. In: Toole JF, ed. Cerebrovascular Disorders. 4^th ed. Baltimore, Md: Lippincott Williams & Wilkins; 1990:519-34.
Weisberg LA. Vascular diseases of the spinal cord. In: Rowland LP, ed. Merritt's Textbook of Neurology. 10^th ed. Baltimore, Md: Lippincott Williams & Wilkins; 2001:271.

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.

View Table List

Read more about Spinal Cord Hemorrhage on Medscape