Spinal Hematoma

A spinal hematoma is an accumulation of blood around the spinal cord.

A spinal hematoma may result from a back injury, a blood vessel (arteriovenous) malformation, a tumor, use of anticoagulants, or a bleeding disorder. A hematoma can compress the spinal cord. Hematomas within the spinal cord, often caused by injuries, are a common cause of compression. Hematomas outside the spinal cord are a relatively rare cause.

Symptoms

A spinal hematoma usually causes sudden pain and tenderness in the affected area, followed by weakness and loss of sensation below the level of the hematoma. Weakness may progress to complete paralysis in minutes or hours, although some people recover spontaneously. If an arteriovenous malformation near the spinal cord ruptures, blood flows upward into the brain, causing headaches and neck stiffness. A hematoma or an injury near the top of the spinal cord can interfere with breathing, because the nerves that supply the diaphragm originate there.

Diagnosis and Treatment

Doctors make a tentative diagnosis based on the symptoms and usually confirm it with magnetic resonance imaging (MRI). Myelography with computed tomography (CT (see Section 6, Chapter 77)) is sometimes used when MRI is not available.

Immediate removal of the accumulated blood by surgical drainage may prevent permanent injury to the spinal cord. Surgery using special techniques (microsurgery) can sometimes correct an arteriovenous malformation. People who are taking anticoagulants or who have a bleeding disorder are given injections of vitamin K and transfusions of plasma to eliminate or reduce the tendency to bleed. If the top of the spinal cord is damaged, a mechanical ventilator is often needed to assist breathing.