Treatment of Intramedullary Spinal Cord Hematoma
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Intramedullary hematoma is an accumulation of blood that has formed in the matter of the spinal cord. The pathology is often combined with vertebral damage and meningeal hemorrhages. The treatment can be either conservative or surgical. An operation to remove the hematoma is required in cases of significant spinal cord compression, which can lead to a severe and irreversible neurological deficit.
Content
Causes
Intramedullary hematoma is usually the result of a spinal injury. It is often accompanied by other injuries – vertebral fractures, injuries of other organs. At the same time, hematomas can form outside the matter of the spinal cord: subdural and epidural.
Other causes are less common. These can be:
- Hemorrhagic spinal stroke.
- Tumors.
- Previous surgical procedures.
- Coagulopathy or taking anticoagulants.
- Arteriovenous malformations.
- Vasculitis.
- Leukemia.
According to the mechanism of the formation of the hematoma, there are three main causes: the effect of excessive force, a violation of blood clotting, or a pathology that increases the likelihood of rupture of blood vessels.
Symptoms
Large foci of hemorrhage are more often formed in the grey matter – it is looser and richer in blood vessels. Its affection causes the development of focal neurological symptoms. Their specifics with hematoma is the sudden appearance and localization mainly on the one side. Typically, the hematoma spans from 2 to 5 segments.
Clinical manifestations depend on the location of the hematoma. The hemorrhage mostly occurs in the region of the central canal of the posterior horns. In this case, pain and temperature sensitivity is impaired. With the formation of the hematoma in the area of the anterior horns, flaccid paresis and muscle atrophy are observed. Pain and worsening of urination control are possible.
In the acute period of the hematoma, even if the focus of hemorrhage itself is small, edema and inflammation always join. Symptoms reach their maximum severity on days 7-10. Then the hematoma begins to dissolve, and the neurological manifestations gradually regress.
Spinal cord intramedullary hematoma is not always isolated. It can come together with meningeal hemorrhages. They are of two types:
- Subarachnoid.
- Epidural.
Subarachnoid hemorrhage is more common. It is manifested by intense back pain, increased tone of the occipital muscles, sensory and pelvic disorders.
Epidural hemorrhage is rare. The main symptom is pain. These hematomas can be large and sometimes cause transverse compression of the spinal cord.
Diagnostics
Patients undergo a neurological diagnostic examination. Doctors study their medical history.
The main method of instrumental diagnostics of hematoma is computed tomography. It is carried out with the use of contrast agents. The CT scan is quick and can be performed even for a seriously ill patient who has recently suffered a spinal injury. For the patients with severe back pain, the CT scan is conducted under sedation.
With the help of computed tomography, the doctor can assess the location of the hematoma, its size, compression of the spinal cord structures, the presence of edema and inflammation. It is possible to determine the causes for the formation of the hematoma, if they have not yet been established. For example, a doctor may find a tumor or an arteriovenous malformation. With spinal injury, the specialists determine the degree of damage to the vertebrae and surrounding tissues.
In a long-term period after an injury or other disease that led to the formation of the hematoma, MRI is considered a more informative method. The technique also makes it possible to evaluate secondary degenerative changes in the spinal cord, which can progress even several months or years after the hemorrhage.
Laboratory methods are of secondary importance. If concomitant subarachnoid hemorrhage is suspected, a lumbar puncture is performed. Blood can be found in the cerebrospinal fluid. A coagulogram and a complete blood count help assess blood clotting and determine platelet levels.
Treatment
First of all, treatment is aimed at eliminating the underlying disease. The hematoma is just one of its manifestations.
The hematoma itself does not always require treatment. Small foci of the hemorrhage resolve on their own. To speed up this process and prevent complications, drug therapy is used.
Although the hematoma disappears over time, recovery of spinal cord function is rarely complete. Weakness in the limbs, muscle atrophy, sensory disorders, urinary incontinence may persist as well. The patients after a previous illness require rehabilitation to prevent disability and improve the quality of life.
With the intramedullary hematoma of the spinal cord, grade 4, a surgical intervention is required. It is important to avoid compression of the spinal cord, as the compressed areas die off and an irreversible neurological deficit develops. In severe cases, complete transverse compression of the spinal cord can occur.
The treatment involves the use of laminectomy – the doctor removes the vertebral arches and eliminates the blood accumulated in the spinal cord. After the operation, neurological symptoms quickly regress.
Additional treatment of the underlying diseases can be required. These can be:
- Correction of coagulopathy, erythrocyte transfusion.
- Removal of the tumor that caused the bleeding.
- Reposition of bone fragments in case of injury.
- Removal of arteriovenous malformations, their clipping or endovascular embolization.
- Chemotherapy for leukemia, etc.
For the prevention of infectious complications, antibiotics are used. In addition, many patients require intensive care and vital signs monitoring.
To undergo treatment of intramedullary hematoma of the spinal cord abroad, please use the services of Booking Health. We will help you find the most suitable spinal cord hematoma treatment clinics and take care of the organization of your trip. On the Booking Health website, you can compare prices for surgical removal of hematoma with decompression and book a medical care program at a favorable price. The cost of treatment for you will be lower due to the lack of additional coefficients for foreign patients.
Authors: Dr. Nadezhda Ivanisova, Dr. Sergey Pashchenko
