Spinal Hematoma Treatment & Management

  • Author: Rod J Oskouian Jr, MD; Chief Editor: Allen R Wyler, MD   more...
 
Updated: Jan 13, 2012
 

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.
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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.

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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.

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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, Congress of Neurological Surgeons, and North American Spine Society

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, and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Scott C Dulebohn, MD  Neurological Surgeon, Appalachian Neurosurgical

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

Allen R Wyler, MD  Former Medical Director, Northstar Neuroscience, Inc

Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons

Disclosure: Nothing to disclose.

Paolo Zamboni, MD  Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy

Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences

Disclosure: Nothing to disclose.

Chief Editor

Allen R Wyler, MD  Former Medical Director, Northstar Neuroscience, Inc

Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons

Disclosure: Nothing to disclose.

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. Mar 2009;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). Sep 2008;48(9):414-7. [Medline].

  3. 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). May 2007;47(5):233-6. [Medline].

  4. 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. May 20 2008;88(19):1306-8. [Medline].

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

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

  7. 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. Jan 1991;41(1):148-50. [Medline].

  8. 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. Feb 13 2009;[Medline].

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

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

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

  12. 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. Jan 26 2009;171(5):334-6. [Medline].

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

  14. 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. Dec 15 2004;29(24):E555-61. [Medline].

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

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

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

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

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

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

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

  22. 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). Nov 24 2011;[Medline].

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

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

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

  26. 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. Nov 2005;57(5):973-83.

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

  28. 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. Sep-Oct 2008;44(5):266-75. [Medline].

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

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

 
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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.
 
 
 
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