Makindo Medical Notes

Related Subjects: |Transverse myelitis |Acute Disseminated Encephalomyelitis |Cervical spondylosis |Spinal Cord Anatomy |Acute Disc Prolapse |Spinal Cord Compression |Spinal Cord Haematoma |Foix-Alajouanine syndrome |Cauda Equina |Conus Medullaris syndrome |Anterior Spinal Cord syndrome |Central Spinal Cord syndrome |Brown-Sequard Spinal Cord syndrome

🚨 Neurological & Neurosurgical Emergency — spinal cord haematoma requires urgent recognition and action. Delay in diagnosis can result in permanent paralysis or death.

📖 About

• Spinal Cord Haematoma: 🩸 Rare but potentially life-threatening condition where bleeding occurs in or around the spinal cord.
• Can be epidural (outside dura, compresses cord), subdural, or intramedullary (within cord tissue).
• Classically presents with sudden, excruciating spinal pain → followed rapidly by acute myelopathy (weakness, sensory loss, sphincter disturbance).

🧬 Causes

• Vascular malformations: AVMs, cavernomas, angiomas.
• Anticoagulation / coagulopathy: Warfarin, heparin, DOACs, haemophilia, thrombocytopenia.
• Iatrogenic: Following lumbar puncture or spinal anaesthesia.
• Spinal cord trauma or surgery.
• Spinal tumours or syringomyelia (predisposing to fragile vessels).
• Rarely: inflammatory causes like transverse myelitis with associated bleeding.

🩺 Clinical Presentation

• ⚡ Sudden, severe back or neck pain, often described as “tearing” or “knife-like.”
• Weakness — initially flaccid (LMN) → may evolve to spastic (UMN).
• 🔻 Sensory level below lesion (loss of pain, temperature, ± dorsal column sparing).
• 🚽 Bowel and bladder dysfunction early in course.
• Symptoms can mimic acute transverse myelitis or cord infarction — but the hyperacute onset is a clue.

🔍 Investigations

• MRI with/without gadolinium: Gold standard — defines site, extent, and differentiates haematoma from tumour or abscess.
• CT spine: May detect blood if MRI unavailable, but less sensitive for intramedullary lesions.
• Bloods: INR, platelets, coagulation profile — assess anticoagulation status.

💊 Management

• 🚨 Immediate reversal of anticoagulation: Vitamin K + Prothrombin Complex Concentrate (PCC, e.g., Octaplex/Beriplex) for warfarin; protamine for heparin.
• 🔪 Surgical clot evacuation (laminectomy or microsurgical decompression): Indicated if significant or progressive neurological deficit.
• Conservative management: Rare; only considered in small haematomas with mild, stable symptoms and no progression.
• Treat underlying cause (e.g., resection of AVM, correct bleeding disorder).
• Spinal neurorehabilitation: Physiotherapy, occupational therapy, bladder/bowel programmes, psychological support.