Idiopathic Spontaneous Intramedullary Hemorrhage: A Report of a Rare Case of Repeated Intramedullary Hemorrhage with Unknown Etiology

Abstract

A 48-year-old woman presented with acute voiding difficulty, numbness and weakness of both lower extremities. Magnetic resonance imaging (MRI) showed an intramedullary hemorrhagic mass that extended from T9 to T10. T8-T10 laminotomy and surgical removal of the hemorrhagic mass was performed. The pathological diagnosis was hematoma. Her neurological status remained the same after the operation. At 5 days post-operation, the patient suddenly became paraplegic, and MRI that was immediately performed revealed a recurrent intramedullary hemorrhage. Emergent surgical evacuation was performed. Again, histological examination showed only hematoma, without any evidence of abnormal vessels or a tumor. A postoperative MRI revealed no abnormal lesions other than those resulting from postoperative changes. At a 9-month follow up, the patient could walk a short distance with the aid of a walker. Because spontaneous intramedullary hemorrhage with unknown etiology is very rare, it is essential to perform a meticulous inspection of the hemorrhagic site to find the underlying cause. Repeated hemorrhage can occur; therefore, close observation of patients after surgery is important in cases without an apparent etiology. Urgent surgical evacuation is important to improve outcomes in these cases.

Intraoperative Ultrasound-assisted Treatment of Idiopathic Spontaneous Intramedullary Hemorrhage: A Case Report and Literature Review

“…There is no clear etiology for idiopathic spontaneous intramedullary hemorrhage and it is usually diagnosed following surgery when no potential pathology is found in macroscopic and microscopic examination [4]. Only a few cases have been reported in the literature [4][5][6][7][8][9][10].…”

“…Almost all of the lesions were located in the thoracic spinal cord, with the exception of one case involving the cervical spinal cord and one case involving the lumbar spinal cord. Idiopathic spontaneous intramedullary hemorrhage is usually characterized by acute onset and rapid deterioration of the neurological state of the patient, characterized by the Brown-Sequard syndrome [4][5][6][7][8][9]. A few patients showed chronic progression [10].…”

“Acute onset tetraplegia associated with immune‐mediated thrombocytopenia and suspected secondary intraspinal hemorrhage in a dog”

“…Intracranial hemorrhage and intraspinal hemorrhage have been reported in association with neonatal alloimmune thrombocytopenia secondary to maternal anti‐human platelet antigen antibody formation . Intraspinal hemorrhage in humans has also been described in association with trauma, lumbar puncture, spinal surgery, coagulopathy, tumors, and vascular malformations as well as of spontaneous, unknown etiology . Clinical signs in people include lower back pain, with or without a radiculopathy.…”

“…9 Intraspinal hemorrhage in humans has also been described in association with trauma, lumbar puncture, spinal surgery, coagulopathy, tumors, and vascular malformations 10 as well as of spontaneous, unknown etiology. 13 Clinical signs in people include lower back pain, with or without a radiculopathy. Rarely, paraplegia or tetraplegia has been described, depending on the site and severity of spinal cord compression.…”

Spontaneous Cervical Intramedullary Hematoma

“…Spinal trauma is the most common cause of intramedullary hematoma. Early surgery is to be performed for pain relief and restoration of neurological functions [1][2][3][4][5][6][7][8][9]. Recently we came across a case of spontaneous cervical intramedullary hematoma with atypical pattern of presentation, hence being reported.…”