Case reportIdiopathic spontaneous intraspinal intramedullary hemorrhage: A report of two cases and literature review
Introduction
Spontaneous intraspinal intramedullary hemorrhage is a rare disease that usually presents as myelopathy. There are limited numbers of reports in the literature, and most of them were caused by vascular lesions, tumors or anticoagulant treatment. A few cases have occurred with unknown etiology [1], [2], [3], [4], [5]. We present two cases of idiopathic spontaneous intramedullary hemorrhage and review the reported literature.
Section snippets
Case 1
A 59-year-old female with underlying diseases of hypertension and diabetes mellitus complained of acute onset of diffuse abdominal pain with fullness sensation and low back pain for four days. She went to the local medical department for help but the situation was not resolved. Sudden onset of paraplegia with paresthesia occurred three days later, so this patient was transferred to our hospital. Trauma history was denied. Initial neurologic examination revealed sensory loss at T8 level with
Discussion
Intraspinal intramedullary hemorrhage is a rare neurological disease which presents as sudden onset of neurologic deficit with subacute, stepwise, or chronic clinical courses. The underlying causes are often difficult to determine if blood products obscure the pathology. Variable causes have been proposed, including trauma, vascular malformations, anti-coagulation, bleeding disorders, primary or metastatic tumors. However, few cases of intraspinal intramedullary hemorrhage with unknown etiology
Conclusion
Idiopathic spontaneous intraspinal intramedullary hemorrhage is very rare. Etiologies such as trauma, vascular lesions, tumors, anticoagulant usage and spinal procedures should be considered first in a patient with spontaneous intramedullary hemorrhage. Timely diagnosis with early surgical intervention for idiopathic spontaneous intramedullary hemorrhage is the most appropriate procedure for better outcome.
References (5)
- et al.
Chronic progressive hematomyelia: case reports and review of the literature
Surgical Neurology
(1999) - et al.
Spinal cord dysfunction caused by non-traumatic hematomyelia
Spinal Cord
(1996)
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