A spinal hematoma is a collection of blood that forms within or around the spinal canal. This accumulation can press on the spinal cord and nerves, potentially disrupting their function. Understanding the signs of this condition can guide appropriate action.
What is a Spinal Hematoma?
A spinal hematoma is an accumulation of blood in the confined space surrounding the spinal cord. This bleeding can occur in different locations: the epidural space (between the dura mater and vertebrae), the subdural space (beneath the dura mater), or within the spinal cord tissue itself (intramedullary hematoma).
The development of a spinal hematoma can stem from various underlying factors. Physical trauma, such as a fall, car accident, or direct injury to the back, represents a common cause. Certain medical conditions that impair blood clotting, including hemophilia or low platelet counts, also increase the risk. Additionally, spinal hematomas can sometimes arise as a complication of medical procedures involving the spine, such as spinal anesthesia, epidural injections, or lumbar punctures.
Common Symptoms to Watch For
One of the most common initial symptoms is the sudden onset of severe back pain. This pain can be localized to the hematoma’s site or radiate to other areas. It is often described as sharp, intense, and persistent, differing from typical muscle strain.
As the hematoma expands and increases pressure, neurological deficits often become apparent. Individuals may experience weakness or numbness in their arms or legs, which can affect one side of the body or both. This weakness can manifest as difficulty lifting limbs, dragging feet, or a general feeling of heaviness. Sensory changes, such as tingling, pins and needles sensations, or a loss of sensation to touch or temperature, commonly occur in the affected areas below the level of compression.
Disruption of bladder and bowel function is another concerning symptom. This can involve difficulty urinating, inability to control bladder or bowel movements (incontinence), or a feeling of incomplete emptying. Difficulty walking, loss of balance, or an unsteady gait can also develop as muscle weakness and sensory deficits progress, making coordinated movement challenging.
How Symptoms Develop and Change
The progression of symptoms in a spinal hematoma can vary significantly, often depending on the cause and the rate at which blood accumulates. In some instances, symptoms may appear very suddenly, within minutes to hours, especially following acute trauma or a rapid bleed. This acute onset can quickly lead to severe neurological impairment as pressure on the spinal cord increases rapidly.
Alternatively, symptoms might develop more gradually over several hours or even days, particularly if the bleeding is slower or less extensive. Initially, an individual might experience mild back pain, which then intensifies, or subtle sensory changes that progressively worsen. The dynamic nature of these symptoms means they can evolve from mild discomfort to profound weakness or paralysis as the hematoma expands.
Continued expansion of the hematoma without intervention can lead to a worsening of neurological deficits. A person might notice a gradual increase in numbness, a spreading of weakness, or new difficulties with movement or sensation that were not present earlier. Monitoring these changes is important as they reflect ongoing compression of spinal structures.
Urgent Signs Requiring Medical Care
Any suspicion of a spinal hematoma warrants immediate medical attention. Prompt diagnosis and treatment are important to prevent permanent neurological damage. Sudden, severe back pain, especially if it appears without a clear reason or is unusually intense, should trigger seeking urgent care.
New neurological symptoms accompanying back pain elevate the urgency. This includes any new onset of weakness, numbness, or tingling in the arms or legs. Difficulty walking, problems with balance, or any changes in the ability to move limbs also constitute urgent signs.
Loss of bladder or bowel control, or any new difficulty with these functions, is a serious symptom requiring immediate evaluation. These red-flag symptoms indicate potential severe compression of the spinal cord. Acting quickly can help preserve spinal cord function and improve outcomes.