Spinal Cord Hemorrhage
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).
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.
Clinical
History
- Intramedullary hemorrhage
- Sudden, severe, localized back pain with or without radicular pain
- Hemiparesis, paraparesis, or quadriparesis
- Sensory loss below the lesion
- Loss of sphincter control
- Spinal subarachnoid hemorrhage
- Sudden, severe, localized back pain with or without radicular pain
- Headache
- Meningismus
- Spinal epidural hemorrhage and spinal subdural hemorrhage
- Sudden, severe, localized back pain with or without radicular pain
- Hemiparesis, paraparesis, or quadriparesis
- Sensory loss below lesion
- Loss of sphincter control
Physical
- Intramedullary hemorrhage - Myelopathy (eg, Brown-Séquard syndrome, central cord syndrome, transection syndrome, conus medullaris syndrome) with or without radiculopathy
- Spinal subarachnoid hemorrhage
- Myelopathy (eg, Brown-Séquard syndrome, transection syndrome, conus medullaris syndrome, cauda equina syndrome) with or without radiculopathy
- Cranial neuropathies
- Papilledema
- May have cutaneous angioma or bruit over the spine
- Spinal epidural hemorrhage and spinal subdural hemorrhage - Myelopathy (eg, Brown-Séquard syndrome, transection syndrome, conus medullaris syndrome, cauda equina syndrome) with or without radiculopathy
Causes
- Intramedullary hemorrhage
- Trauma
- Vascular malformations
- Bleeding diatheses
- Anticoagulants
- Hemorrhage into tumor
- Venous infarction
- Spinal subarachnoid hemorrhage
- Spinal angioma
- Spinal artery aneurysm
- Intracranial aneurysm
- Bleeding diatheses
- Anticoagulants
- Polyarteritis nodosa
- Hemorrhage into tumor
- Trauma
- Lumbar puncture
- Spinal epidural hemorrhage
- Spontaneous
- Trauma
- Liver disease with portal hypertension
- Bleeding diatheses
- Lumbar puncture
- Epidural anesthesia
- Epidural vascular malformation
- Spinal subdural hemorrhage
- Bleeding diatheses
- Anticoagulants
- Trauma
- Lumbar puncture
- Vascular malformations
- Spinal surgery
- Spontaneous
