Spinal Hemorrhage: An Interdisciplinary Emergency

Aims: Experience with spinal bleeding in childhood and adolescence is limited. In the literature, most cases were reported in association with hemophilia.

Methods: We report the case of a four children (age 4, 5, 9, and 14 years; two girls, two boys) with spinal hemorrhage who were treated at our hospital within the last 2 years.

Results: In one child, subdural bleeding was associated with multiple vertebral body fractures which resulted from an acute spinal trauma. No spinal cord compression was present. The child recovered completely without specific treatment of the hemorrhage.

The remaining three patients acutely presented with spinal pain (n = 2), headache (n = 1), flaccid paralysis of the legs (n = 2), tetraplegia (n = 1), and combined bowel and bladder dysfunction (n = 3), respectively. In two of these children, epidural bleeding was detected. Hemilaminectomy performed within 48 hours resulted in almost complete clinical recovery whereas angiography did not reveal a vascular malformation.

The third child suffered from acute extensive bleeding within the thoracic spinal cord. Seven days after manifestation when first presenting at our hospital, a thoracic arteriovenous malformation could be detected. Despite endovascular embolization treatment marked paraplegia with combined bowel and bladder dysfunction persisted.

Each of the four children underwent spinal imaging by MRI as part of emergency diagnostic, however, spinal DSA was needed to distinguish the causal pathology.

Conclusion: The combination of acute, severe pain (head and spine) and acute limb paralysis is highly indicative for spinal hemorrhage and demands immediate imaging. Rapid surgical intervention and endovascular treatment of vascular malformations may be necessary to prevent serious long-term sequelae.

Keywords: spinal hemorrhage, magnetic resonance imaging, digital subtraction angiography, endovascular embolization.