Spinal cord hemorrhage

　　Spinal cord hemorrhage can be intramedullary， subarachnoidal， subdural or epidural. It is rare， more frequent in men. In many cases the etiology remains undiscovered. It may be caused by trauma， anticoagulation， hereditary or acquired bleeding disorders or bleeding from spinal vascular malformations， spinal artery aneurysms or spinal cord tumors. In hematomyelia blood disrupts gray matter more than white matter. Spinal subarachnoidal hemorrhage accounts for less than 1% of all subarachnoidal hemorrhages. Spinal epidural hemorrhage occurs at least 4 times more frequent than spinal subdural hemorrhage. Patients with spinal cord hemorrhage usually present with acute symptoms with back or neck pain that may be intense， knife-like and is often radiating. Patients with spinal subarachnoidal hemorrhage may additionally show symptoms resembling meningitis or cranial subarachnoidal hemorrhage， such as meningeal irritation with headache， neck stiffness， disturbance of consciousness and epileptic seizures and are often misdiagnosed as having cerebral hemorrhage.

　　Specific treatment of acute spinal cord hemorrhage is surgical. Stopping of the bleeding， decompression of neural structures and removal of the hematoma are aimed at in surgery. Conservative treatment may be applicable in selected cases. Underlying spinal vascular malformations should be treated as listed below. Vitamin K， fresh frozen plasma， prothrombin complex， platelet transfusions and specific clotting factor concentrates may be pharmacological treatment options.

　　Spinal vascular malformations

　　Spinal dural arteriovenous fistulas (AVF)， arteriovenous malformations (AVM) and cavernous angiomas are the most frequent spinal vascular malformations.

　　Dural AVF are most frequently seen， usually after the fourth decade in men and are probably acquired. A venous congestion caused by arterial overload of venous drainage due to the fistulas， initiates edema and mostly slowly rogressive， often step-wise myelopathy， rarely myeloradiculopathy. Spinal cord hemorrhage is almost never seen. Early recognition of spinal dural AVF with subsequent aggressive treatment without delay may best prevent further neurologic decline. Occlusion of the fistula by surgery or endovascular embolization is indicated and can stabilize or even improve the clinical condition. Spontaneous short- and medium-term outcome is poor.

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