Spinal cord haemorrhage (Haematomyelia)

Aetiology

  • result of trauma,
  • vascular malformation,
  • bleeding into an intramedullary metastasis,
  • primary coagulation disorder,
  • use of anticoagulants.

In other cases, no underlying cause is found.

Clinical symptoms

The presentation is of a sudden spinal cord syndrome, usually with pain at the level of the haemorrhage, followed quickly by the development of a transverse cord syndrome with loss of motor and sensory function below the level of the lesion.

The clinical symptoms may therefore be indistinguishable from those due to epidural or subdural haemorrhage or from those of acute infarction of the spinal cord, although if the latter is due to anterior spinal artery occlusion, there will be sparing of posterior column sensation.

MRI

The diagnosis will be made from MRI, which should be obtained immediately; the cord will be swollen at the level of the haemorrhage and signal loss on T2-weighted sequences due to the effects of deoxyhaemoglobin is apparent if the haemorrhage is more than a few hours old.

Treatment

Surgical evacuation of a discrete haematoma may be performed, although the benefits of this approach are uncertain.