Spinal Cord Hemorrhage Clinical Presentation

Updated: Feb 19, 2019
  • Author: Morteza Sadeh, MD, PhD, MS; Chief Editor: Helmi L Lutsep, MD  more...
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Presentation

History

The presentation of all types of spinal cord hemorrhage varies based on the acuity of the hemorrhage as well as the longitudinal and cross-sectional extent of the hemorrhage and its rate of expansion. The following descriptions are typical, but not absolute.

Intramedullary hemorrhage / hematomyelia

Clinical presentation may include the following:

  • Sudden, severe, localized back pain, with or without radicular pain
  • Pain is usually centered in back or neck, and often radiates in the dermatomal distribution of the level of the hemorrhage
  • Hemiparesis, paraparesis, or quadriparesis
  • Sensory loss below the hematoma
  • Loss of sphincter control

Spinal SAH

Clinical presentation may include the following:

  • Sudden, severe, localized spinal pain with or without radicular pain
  • Headache
  • Meningismus
  • Acute onset of neck, thoracic, or back pain was described as “le coup de poignard” or “the strike of the dagger” by Michon is a hallmark of SAH of the spine (Michon 1928).

Spinal EDH and SDH

Clinical presentation may include the following:

  • Sudden, severe, localized back pain (mostly in cervical and thoracic regions due to higher prevalence of hemorrhage in these region) with or without radicular pain
  • Hemiparesis, paraparesis, or quadriparesis
  • Sensory loss below the hematoma
  • Loss of sphincter control
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Physical

Intramedullary hemorrhage / hematomyelia

Physical examination may reveal the following:

  • Myelopathy (e.g., Brown-Séquard syndrome, central cord syndrome, transection syndrome, conus medullaris syndrome) with or without radiculopathy.

Spinal SAH

Physical examination may reveal the following:

  • Varying degree of myelopathy (e.g., Brown-Séquard syndrome, transection syndrome, conus medullaris syndrome, cauda equina syndrome) with or without radiculopathy.
  • Menigismus might be present and may point to concurrent presence of cranial SAH
  • Cranial neuropathies
  • Papilledema
  • May have cutaneous angioma or bruit over the spine in case of AVM and dural AVF, respectively

Spinal EDH and SDH

Physical examination may reveal the following:

  • Myelopathy (e.g., Brown-Séquard syndrome, transection syndrome, conus medullaris syndrome, cauda equina syndrome) with or without radiculopathy.
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Causes

Intramedullary hemorrhage / hematomyelia

Causes may include the following:

  • Trauma
  • Vascular malformations
  • Bleeding diatheses
  • Anticoagulants
  • Hemorrhage into tumor
  • Venous infarction
  • Spinal radiation
  • Gower's intrasyringal hemorrhage

Spinal SAH

Causes may include the following:

  • Spinal angioma
  • Spinal artery aneurysm
  • Intracranial aneurysm
  • Bleeding diatheses
  • Anticoagulants
  • Polyarteritis nodosa
  • Hemorrhage into tumor
  • Trauma

Spinal EDH

Causes may include the following:

  • Spontaneous
  • Trauma
  • Liver disease with portal hypertension
  • Bleeding diatheses
  • Lumbar puncture
  • Epidural anesthesia
  • Epidural vascular malformation

Spinal SDH

Causes may include the following:

  • Bleeding diatheses
  • Anticoagulants
  • Trauma
  • Lumbar puncture
  • Vascular malformations
  • Spinal surgery
  • Spontaneous
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