Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Spinal Hematoma Treatment & Management

  • Author: Rod J Oskouian, Jr, MD; Chief Editor: Brian H Kopell, MD  more...
 
Updated: Nov 10, 2015
 

Surgical Therapy

 

Surgical treatment varies with individual physicians and the underlying pathology. Some surgeons believe that urgent clot evacuation is necessary, while others contest that early exploration damages otherwise viable spinal neurons.

Surgeons who believe in clot evacuation operate immediately upon diagnosing a clot. Their rationale assumes an urgent need to remove mass effect and pressure from the spinal cord.

Less aggressive surgeons believe that the neurologic deficit should plateau before removing the clot to keep from damaging viable tissue.

Regardless of the timing, both groups of surgeons believe that the underlying pathology must be addressed. Any accompanying disorders, such as clotting problems, should be corrected as soon as possible. Intraspinal tumors should be surgically removed using the tenets of individual tumor management, while AVMs are managed by embolization, surgical removal, or a combination of those modalities.

Because of the paucity of cases, empirical data do not exist to clarify which treatment course provides a better outcome.

Next

Outcome and Prognosis

Too few data are available to derive solid outcome and prognosis figures for this disease. As noted above, however, the ultimate outcome of a patient correlates strongly with their initial neurological status; in other words, a patient with minimal findings upon presentation will likely experience a much better outcome than a patient who presents with a significant neurological deficit.

Previous
Next

Future and Controversies

Spinal cord hematoma or hematomyelia is a fairly rare entity that is usually caused by some underlying pathology or disease process. These causative diseases include AVMs, coagulopathies, tumors, syringomyelia, and vasculitis. No associated problems occur in a subset of these patients.

Clinical presentation is usually a sudden onset of spinal pain accompanied by neurological deficits correlative with the site of the clot. Treatment is aimed at correcting the underlying pathology or clotting disorder and at removing the clot. Timing of treatment and its results are still controversial.

Previous
 
Contributor Information and Disclosures
Author

Rod J Oskouian, Jr, MD Consulting Physician, Swedish Neuroscience Specialists, Swedish Neuroscience Institute, Seattle

Rod J Oskouian, Jr, MD is a member of the following medical societies: American Association of Neurological Surgeons, American Medical Association, North American Spine Society, Congress of Neurological Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Charles E Rawlings III, MD Consulting Surgeon, Department of Neurosurgery, Rawlings Neurosurgical Consulting

Charles E Rawlings III, MD is a member of the following medical societies: American Association of Neurological Surgeons, American College of Surgeons, 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.

Chief Editor

Brian H Kopell, MD Associate Professor, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai

Brian H Kopell, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Neurological Surgeons, International Parkinson and Movement Disorder Society, Congress of Neurological Surgeons, American Society for Stereotactic and Functional Neurosurgery, North American Neuromodulation Society

Disclosure: Received consulting fee from Medtronic for consulting; Received consulting fee from St Jude Neuromodulation for consulting; Received consulting fee from MRI Interventions for consulting.

References
  1. Pobiel RS, Schellhas KP, Eklund JA, Golden MJ, Johnson BA, Chopra S, et al. Selective cervical nerve root blockade: prospective study of immediate and longer term complications. AJNR Am J Neuroradiol. 2009 Mar. 30(3):507-11. [Medline].

  2. Miyakoshi N, Hongo M, Kasukawa Y, Ando S, Shimada Y. Thoracic disk herniation with hematoma--case report. Neurol Med Chir (Tokyo). 2008 Sep. 48(9):414-7. [Medline].

  3. Agarwal A, Kanekar S, Thamburaj K, Vijay K. Radiation-induced spinal cord hemorrhage (hematomyelia). Neurol Int. 2014 Oct 23. 6 (4):5553. [Medline].

  4. Famularo G, Sajeva MR, Gasbarrone L. Warfarin-associated hematomyelia. Intern Med. 2014. 53 (6):623-6. [Medline].

  5. Saliou G, Tej A, Theaudin M, Tardieu M, Ozanne A, Sachet M, et al. Risk factors of hematomyelia recurrence and clinical outcome in children with intradural spinal cord arteriovenous malformations. AJNR Am J Neuroradiol. 2014 Jul. 35 (7):1440-6. [Medline].

  6. Matsui T, Taniguchi T, Saitoh T, Kamijoh K, Nakamura T, Yamashita A, et al. Hematomyelia caused by ruptured intramedullary spinal artery aneurysm associated with extramedullary spinal arteriovenous fistula--case report. Neurol Med Chir (Tokyo). 2007 May. 47(5):233-6. [Medline].

  7. Che XM, Xu QW, Shou JJ, Gu SX, Zhang MG, Sun B, et al. [The diagnosis and surgical management for intramedullary spinal cord cavernous angioma]. Zhonghua Yi Xue Za Zhi. 2008 May 20. 88(19):1306-8. [Medline].

  8. Schenk VWD. Haemorrhages in spinal cord with syringomyelia in a patient with haemophilia. Acta Neuropathol. 1963. 2:306-308.

  9. Wisoff JH, Rovit RL, Ho V. Spontaneous hematomyelia secondary to factor XI deficiency. Case report. J Neurosurg. 1985 Aug. 63(2):293-5. [Medline].

  10. Allen JC, Miller DC, Budzilovich GN. Brain and spinal cord hemorrhage in long-term survivors of malignant pediatric brain tumors: a possible late effect of therapy. Neurology. 1991 Jan. 41(1):148-50. [Medline].

  11. Cassinotto C, Deramond H, Olindo S, Aveillan M, Smadja D, Cabre P. MRI of the spinal cord in neuromyelitis optica and recurrent longitudinal extensive myelitis. J Neuroradiol. 2009 Feb 13. [Medline].

  12. Gowers WR. A Manual of Diseases of the Nervous System. Diseases of the Spinal Cord and Nerves. 1886.

  13. Brandt M. Spontaneous intramedullary haematoma as a complication of anticoagulant therapy. Acta Neurochir (Wien). 1980. 52(1-2):73-7. [Medline].

  14. Leech RW, Pitha JV, Brumback RA. Spontaneous haematomyelia: a necropsy study. J Neurol Neurosurg Psychiatry. 1991 Feb. 54(2):172-4. [Medline].

  15. Trautner S, Pedersen H, Bendtson I. [Neuromyelitis optica with atypical cerebral lesions demonstrated by magnetic resonance imaging in a 9-year old girl]. Ugeskr Laeger. 2009 Jan 26. 171(5):334-6. [Medline].

  16. Banczerowski P, Vajda J, Veres R. [Removal of intraspinal space-occupying lesions through unilateral partial approach, the "hemi-semi laminectomy"]. Ideggyogy Sz. 2008 Mar 30. 61(3-4):114-22. [Medline].

  17. Borm W, Mohr K, Hassepass U, Richter HP, Kast E. Spinal hematoma unrelated to previous surgery: analysis of 15 consecutive cases treated in a single institution within a 10-year period. Spine. 2004 Dec 15. 29(24):E555-61. [Medline].

  18. Constantini S, Ashkenazi E, Shoshan Y. Thoracic hematomyelia secondary to coumadin anticoagulant therapy: a case report. Eur Neurol. 1992. 32(2):109-11. [Medline].

  19. Hamlat A, Adn M, Ben Yahia M, et al. Gowers intrasyringal hemorrhage. Case report and review of the literature. J Neurosurg Spine. 2005 Dec. 3(6):477-81.

  20. Kumar S, Kumar Jaiswal A, Singh H. Spontaneous intramedullary hematoma. A case report. J Neurosurg Sci. 2005 Mar. 49(1):21-3; discussion 23.

  21. Lee DS, Kobrine A. Neurogenic pulmonary edema associated with ruptured spinal cord arteriovenous malformation. Neurosurgery. 1983 Jun. 12(6):691-3. [Medline].

  22. McCormick PC, Michelsen WJ, Post KD. Cavernous malformations of the spinal cord. Neurosurgery. 1988 Oct. 23(4):459-63. [Medline].

  23. McCormick PC, Torres R, Post KD. Intramedullary ependymoma of the spinal cord. J Neurosurg. 1990 Apr. 72(4):523-32. [Medline].

  24. Odom GL, Woodhall B, Margolis G. Spontaneous hematomyelia and angiomas of the spinal cord. J Neurosurg. 1957. 14:192-202.

  25. Onda K, Yoshida Y, Arai H, Terada T. Complex arteriovenous fistulas at C1 causing hematomyelia through aneurysmal rupture of a feeder from the anterior spinal artery. Acta Neurochir (Wien). 2011 Nov 24. [Medline].

  26. Oyanagi K, Yamazaki K, Hinokuma K. An autopsy case of intramedullary venous malformation of the spinal cord with spreading hematomyelia. Clin Neuropathol. 1990 May-Jun. 9(3):148-51. [Medline].

  27. Perot P, Feindel W, Lloyd-Smith D. Hematomyelia as a complication of syringomyelia: Gowers'' syringal hemorrhage. Case report. J Neurosurg. 1966 Oct. 25(4):447-51. [Medline].

  28. Pisani R, Carta F, Guiducci G. Hematomyelia during anticoagulant therapy. Surg Neurol. 1985 Nov. 24(5):578-80. [Medline].

  29. Rodesch G, Hurth M, Alvarez H, et al. Spinal cord intradural arteriovenous fistulae: anatomic, clinical, and therapeutic considerations in a series of 32 consecutive patients seen between 1981 and 2000 with emphasis on endovascular therapy. Neurosurgery. 2005 Nov. 57(5):973-83.

  30. Sato K, Kubota T, Ishida M, Handa Y. Spinal tanycytic ependymoma with hematomyelia--case report--. Neurol Med Chir (Tokyo). 2005 Mar. 45(3):168-71.

  31. Thibaud JL, Hidalgo A, Benchekroun G, Fanchon L, Crespeau F, Delisle F, et al. Progressive myelopathy due to a spontaneous intramedullary hematoma in a dog: pre- and postoperative clinical and magnetic resonance imaging follow-up. J Am Anim Hosp Assoc. 2008 Sep-Oct. 44(5):266-75. [Medline].

  32. Tubbs RS, Smyth MD, Wellons JC, Oakes WJ. Intramedullary hemorrhage in a neonate after lumbar puncture resulting in paraplegia: a case report. Pediatrics. 2004 May. 113(5):1403-5.

  33. Wisoff HS. Spontaneous intraspinal hemorrhage. In: Wilkins RH, Rengachary SS. eds. Neurosurgery. 2nd ed, Vol. 2. New York: McGraw-Hill. 1996:2559-65.

 
Previous
Next
 
This T1-weighted sagittal MRI is from a 19-year-old man with 4-month history of progressive motor loss and an inability to ambulate. He underwent spinal biopsy that confirmed an intramedullary glioblastoma.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.