A spinal hemorrhage is bleeding that occurs in or around the spinal cord. Because the spinal canal is a confined space, this event can create pressure on the cord, disrupting its ability to send and receive nerve signals. Even a small amount of blood can have significant effects. Understanding this condition involves recognizing its causes, symptoms, and required medical responses.
Causes and Risk Factors
The causes of a spinal hemorrhage are either traumatic or non-traumatic. Traumatic injuries from events like car accidents or falls are the most common source, damaging blood vessels and forming a blood clot (hematoma). Non-traumatic hemorrhages are often linked to underlying medical conditions.
Vascular abnormalities, such as arteriovenous malformations (AVMs) where arteries and veins are abnormally connected, can rupture and bleed. Spinal tumors can also cause hemorrhage, as can certain medical procedures like lumbar punctures or the placement of epidural catheters.
Several factors increase the risk of a spinal hemorrhage. Anticoagulant medications (blood thinners) interfere with the body’s clotting process. Underlying bleeding disorders, such as hemophilia, also predispose a person to spontaneous bleeding, while uncontrolled high blood pressure can weaken blood vessel walls.
Identifying Symptoms
The symptoms of a spinal hemorrhage often appear suddenly. A primary symptom is the abrupt onset of intense, localized pain in the back or neck, which can radiate into the arms or legs, a condition known as radicular pain. The specific combination of symptoms is directly related to the location and size of the hemorrhage.
Neurological deficits are a common consequence of the pressure exerted by the hematoma. Motor symptoms can range from muscle weakness to complete paralysis. Sensory changes are also frequent, including numbness, tingling, or a loss of feeling.
A loss of bowel or bladder control indicates significant spinal cord compression. Bleeding in the cervical (neck) region will affect the arms and legs, while a bleed in the lumbar (lower back) area primarily impacts the legs.
The Diagnostic Process
Diagnosing a spinal hemorrhage begins with a clinical evaluation. A physician performs a detailed neurological exam to assess muscle strength, sensation, and reflexes and reviews the patient’s medical history. This initial assessment helps pinpoint the location and severity of the injury.
Imaging studies are required to confirm the presence of a hemorrhage and identify its precise location and size. Magnetic Resonance Imaging (MRI) is the most effective diagnostic tool, using powerful magnets and radio waves to create detailed images of the spinal cord, surrounding soft tissues, and any collected blood.
In situations where an MRI is not available, a Computed Tomography (CT) scan may be used. A CT scan uses X-rays to create cross-sectional images of the spine and can detect blood, though it is less detailed than an MRI for visualizing the cord itself. Sometimes, a CT myelogram, which involves injecting contrast dye into the spinal canal before the scan, is performed to enhance the images.
Treatment Approaches
The primary goal of treatment for a spinal hemorrhage is to relieve pressure on the spinal cord as quickly as possible to prevent permanent damage, and it is often considered a medical emergency. The course of action depends on the bleed’s size and cause and the severity of neurological symptoms.
Surgical intervention is frequently the main treatment for significant spinal cord compression. A common procedure is an emergency decompressive laminectomy, where a surgeon removes a portion of the vertebral bone called the lamina. This creates more space, allowing the surgeon to evacuate the blood clot.
Alongside surgery, medical management is employed. If the patient is on anticoagulant medications, these are stopped, and reversal agents may be administered. Blood pressure is also carefully controlled to reduce the risk of further bleeding without compromising blood flow to the injured spinal cord.
Recovery and Prognosis
The long-term outlook following a spinal hemorrhage is variable. A person’s prognosis depends on the severity of their initial symptoms and the speed with which they receive treatment. Early intervention to decompress the spinal cord improves the chances of a favorable outcome.
Rehabilitation is a key part of the recovery process. Physical therapy is initiated to help patients regain muscle strength, improve mobility, and restore balance. Occupational therapy focuses on helping individuals relearn the skills needed for daily activities, such as dressing and bathing.
The intensity and duration of rehabilitation are tailored to each patient’s needs. Potential long-term outcomes range from a full recovery to permanent neurological issues, including chronic pain, persistent muscle weakness, or paralysis. Complications such as sexual dysfunction or lasting problems with bowel and bladder control can also occur.