Multifocal Intramedullary Hemorrhages without Identifiable Predisposing or Precipitating Causes

Abstract

Spinal cord disease can present in a variety of ways with acute, subacute or chronic onset, and clinical symptoms may vary from incomplete syndromes to complete quadriparesis. Acute quadriparesis beginning with excruciating pain in the chest and back progressing over a short period to quadriparesis is highly suggestive of spinal hemorrhage which can be epidural, subdural, subarachnoid or intramedullary. Intramedullary hemorrhage is the least common type and is mostly associated with predisposing focal diseases like tumor, AVM, cavernomas, spinal artery aneurysm, or due to generalized hematological coagulation abnormality. Nevertheless, spontaneous hematomyelia is also described which can be patchy with more than one segment involvement separated with a non involved segment of cord. We describe a young hematomyelia patient with such a multifocal long segment involvement of the spinal cord on MRI extending from the lower medulla to the conus.