Conservative Management and Early Intensive Rehabilitation Following Haemorrhage of a Thoracic Intramedullary Spinal...

Spinal cord cavernous malformations (SCCMs) are rare vascular malformations of the spinal cord that may present with acute neurological deterioration in the event of haemorrhage. We report the case of a 21-year-old woman who presented with sudden bilateral lower limb weakness and paraesthesia. She experienced a rapid neurological decline leading to paraplegia and urinary retention. MRI demonstrated a haemorrhagic intramedullary cavernoma at the T12 level with associated cord oedema. Surgical intervention was deferred in the acute phase, given the extent of haemorrhage-related oedema and unclear lesion margins, and conservative management was initiated alongside early intensive neurorehabilitation. The patient subsequently showed significant improvement, progressing from Modified McCormick grade 5 to grade 3 within weeks. By six months, she achieved independent transfers, ambulation with crutches, and functional independence in most activities of daily living, although bladder dysfunction persisted. Follow-up MRI showed a stable lesion with no further haemorrhage. This case illustrates that conservative management with early multidisciplinary neurorehabilitation may facilitate meaningful recovery while neurosurgical planning is underway.