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Thread: Possible causes of hemorrhage in spinal cord

  1. #1
    Senior Member KDK513's Avatar
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    Possible causes of hemorrhage in spinal cord

    I am still searching for the possible cause of the hemorrhage my husband had in his spinal cord. The Doctors have said it is impossible to know for sure because the initial presence of the blood clot concealed the "injury site" on subsequent MRI's. Four months later the clot had dissipated and the MRI showed nothing conclusive.
    The suspected causes were either a cavernous malformation or arteriovenous fistula, more lokely the second.

    My husband had surgery for a herniated disc, L5 in Sept. 1992 - no complications. He was in a serious head on car crash in Oct. 1993 that resulted in severe lower back pain which was releived with physical therapy. In June, 1999 he had another disc surgery, L4, initially following he felt pretty good. Four weeks later he was in another car accident. The Doctor ordered an MRI of his lumbar area and thought everything looked OK. Within a couple weeks his back began to hurt again. He seemed tired much of the time and never seemed to recover fully to his previous level of activity. In Dec. 1999 he began to experience occasional sharp pain in his chest and finally a hemorrhage in the thoracic area resulting in paralysis at T4. This time an MRI was done of his entire spine which revealed 3 herniated discs in his neck. The Doctors were very concerned about this but because he has not experienced discomfort at this level the decision was made to work on rehab first and not treat the cervical problems.

    I believe this could all be related, but have had diificulty finding information that ties this all together. Any suggested sites or research been done that could gives us some much needed answers. Many thanks! Kathy

  2. #2
    Kathy,

    Hi. This forum is for research articles but I will answer here, leave it here for a while and then move this to the care forum. I visit all the forums and will address as many questions and postings as I can.

    Your husband's situation sounds very complicated. He has multiple reasons for spinal cord injury. After having been in so many car accidents, it is no surprising that he has a variety of spinal problems. However, if his doctors suspect the possibility of an arteriovenous malformation or fistula is suspected that cannot not be seen on MRI, the next step for a definitive diagnosis is an arteriogram.

    Hemorrhage in the spinal cord would suggest that he has some abnormality of the blood vessels that is responsible for the hemorrhage. On the other hand, you are not describing a neurological picture that suggests that he has had a serious spinal cord injury with motor and sensory loss at T4. The history that you described of him having a pain in his chest is worrisome and I am concerned that not all the different options are being considered.

    Wise.

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    Senior Member KDK513's Avatar
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    I posted here because I have been looking for any research that has been done that may explain a fistula or malformation may be caused by trauma or injury and not necessarily a birth defect. He had an arteriogram the following day, very extensive. Following the procedure, the Doctor said to me "unfortunately no malformation was found". I thought this was an odd response until he further explained that what he meant was he could not find a cause. After viewing the results of an MRI four months later his Neurologist felt confident stating that no malformations were curently present and he did not expect another reoccurance. It was speculated that the pain in his chest was caused by miniscule amounts of blood leaking from the source of whatever caused this. Sorry for posting in the wrong place, please move me. I was hoping someone may be familiar with a similar case, study, or research. Any information is welcome. Many thanks, Kathy

  4. #4
    KDK513, thanks for explaining. An angiogram is the definitive test for the presence of arteriovenous malformations. If they cannot be found, it suggests that there is no malformation or at least no malformation can be fixed either via interventional neuroradiology or surgical approaches.

    The question that remains is whether and what are some of the other causes of spinal cord hemorrhage. I will look to see. It can happen and probably more frequently than we suspect. I know of a number of people who have had what are called "spinal strokes" and there did not seem to be any arteriovenous malformation or other explanation for such events. Often, when no cause for such an event can be found, it is often ascribed to transverse myelitis or "spinal stroke".

    Does your husband have a sensory level, i.e. a level below which his sensation is abnormal or absent?

    Wise.

  5. #5
    KDK513 (Kathy), I am sure that you know the following but the following is a good description of the diagnostic process and the differential diagnosis of spinal cord hemorrhage. As pointed out, spinal cord hemorrhage is rare, constituting less than 1% of all subarachnoid hemorrhages.

    http://www.emedicine.com/neuro/topic347.htm

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    Senior Member KDK513's Avatar
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    Thank you for the information

    I have read as much as I could find and comprehend on this subject, but until recently had never found any sources that support my need to connect his history of injury/ surgery/ ? Everything I read supported the concept of 'birth defect'. Then I worried about his identical twin, as well as, our son.

    Dr. Young this is exactly the type of information I have been searching for. I am very grateful for your patience as I try to recall the details of all that has happened. It was an angiogram that he had on Christmas Eve ( I had to go back through my notes). The Neurosurgeon who had performed his most recent lumbar surgery sat with me along with so many others while the procedure was done.

    We have been told how rare this is, but noone would make any connection between trauma and this occurrance. I have printed out this site and will read through it more thoroughly in the morning. If my initial understanding of this is correct then his history is all connected? We just want to understand what has happened. Many thanks for your help.

  7. #7
    Senior Member KDK513's Avatar
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    The last time my husband was examined by his Physiatrist (July 2001) he said his sensory level was T12 and motor level T7. His blood clot was originally T4. Is this the information you requested of me? Kathy

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