Makindo Medical Notes

Related Subjects: | Transverse myelitis | Acute Disseminated Encephalomyelitis |Cervical spondylosis |Spinal Cord Anatomy |Acute Disc Prolapse |Spinal Cord Compression |Spinal Cord Haematoma |Foix-Alajouanine syndrome |Cauda Equina |Conus Medullaris syndrome |Anterior Spinal Cord syndrome |Central Spinal Cord syndrome |Brown-Sequard Spinal Cord syndrome

Neurological and Neurosurgical Emergency

About

• Spinal Cord Haematoma: A potentially life-threatening condition characterized by severe back pain and acute myelopathy due to bleeding in the spinal cord area.
• Commonly associated with anticoagulant use, arteriovenous malformations (AVMs), trauma, or spinal vascular malformations.

Causes

• Vascular Malformations: Includes AVMs, angiomas, or other spinal vascular anomalies.
• Anticoagulation Therapy: Associated with medications like Warfarin or Heparin, or conditions like haemophilia.
• Transverse myelitis
• Spinal cord tumors
• Spinal cord trauma
• Syringomyelia
• Complications following lumbar puncture

Clinical Presentation

• Intense, sudden-onset spinal pain, often described as excruciating.
• Initial flaccid weakness that may later transition to spasticity.
• Distinct sensory level with sensory loss below the level of the haematoma.
• Loss of bowel and bladder control, indicative of spinal cord involvement.

Investigations

• CT Scan: Useful in identifying blood if MRI is unavailable or contraindicated.
• MRI with or without gadolinium: The preferred diagnostic imaging to confirm haematoma and exclude differential pathologies like tumors or vascular lesions.

Management

• Conservative Management: May be considered in stable cases with minimal neurological impairment and close monitoring.
• Surgical Clot Evacuation: Indicated in cases with significant neurological deficits or progressive symptoms.
• Reversal of Anticoagulation: If on Warfarin, administer Vitamin K and clotting factor concentrates (e.g., Octaplex or Beriplex) to mitigate further bleeding.
• Identify and treat the underlying cause, such as AVM or bleeding disorder.
• Spinal Neurorehabilitation: Comprehensive rehabilitation in the post-acute phase for functional recovery, mobility support, and adaptive training as needed.