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