Multifocal Intramedullary Hemorrhages without Identifiable Predisposing or Precipitating Causes. A Case Report

Area of Science:

• Neurology
• Radiology

Background:

• Spinal cord diseases present with diverse onset and symptoms, ranging from incomplete syndromes to complete quadriparesis.
• Acute quadriparesis with severe back and chest pain suggests spinal hemorrhage (epidural, subdural, subarachnoid, or intramedullary).
• Intramedullary hemorrhage, the least common type, is often linked to underlying conditions like tumors, vascular malformations, or coagulation disorders.

Purpose of the Study:

• To describe a rare case of spontaneous intramedullary hemorrhage with extensive, multifocal spinal cord involvement.
• To illustrate the varied presentation of spinal cord diseases and the diagnostic utility of MRI.

Main Methods:

• Case report of a young patient presenting with acute neurological deficits.
• Magnetic Resonance Imaging (MRI) of the entire spine was performed to evaluate the extent of spinal cord involvement.

Main Results:

• The patient presented with acute quadriparesis and severe pain, indicative of spinal hemorrhage.
• MRI revealed multifocal, long-segment intramedullary hemorrhage extending from the lower medulla to the conus.
• This pattern of involvement is atypical for spontaneous hematomyelia.

Conclusions:

• Spontaneous intramedullary hemorrhage can present with extensive and multifocal spinal cord lesions, challenging typical diagnostic patterns.
• Advanced imaging like MRI is crucial for delineating the full extent of spinal cord pathology.
• This case expands the understanding of rare spinal cord hemorrhage presentations.