Spontaneous Hemorrhage of Thoracic Cavernous Malformation Leading to Bilateral Lower Extremity Paralysis

Cavernous malformations (CMs) are abnormal clusters of thin-walled blood vessels located in the central nervous system. An 87-year-old male with a history of heart failure with reduced ejection fraction, coronary artery disease, and atrial fibrillation on rivaroxaban was admitted for acute onset, bilateral lower extremity weakness. He was found to have hemorrhagic transformation of a pre-existing spinal cord cavernous malformation located at the level of T9 of the thoracic column worsened by his use of anticoagulation. Surgical resection remains the only definitive management. Patients at high risk for surgical intervention are managed with supportive care and physical therapy.