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Thread: Sponataneous Intra dural heamatoma leading to paraplegia

  1. #1

    Sponataneous Intra dural heamatoma leading to paraplegia

    My 66year old father developed a sudden pain in his thoracolumber region with paraplegia and bowel bladder involvement with sensory level D6.His MRI spine was suggestive of a large intradural haematoma D1-D10 emergency surgery for exploration, evacuation of haematoma with D2-D9 laminoplasty,Spinal cord was healthy and pink. Post op MRI revealed adequate spinal canal decompression with extensive area of altered cord signal at dorsal level s/o myelomalacia. He is an ASIA A .Sensory level D8 motor 0 sensory 0 paraplegia with bowel, bladder involvement.

    We are willing to explore stem cell therapy as we are hopeful of his recovery.We live in India. If anyone has any info which can be of help pl let me know. Its now four months since this incident.

    We are worried that there could a relapse of the incident. No cause of the bleeding was found. Could an invasive MRI determine any AVMs? Can something be done to prevent another mishap?

    Thanks.

    Vandana

  2. #2
    Welcome to our forums.

    How long ago did this occur? It is common for those with vascular spinal cord injuries to gain some return for up to 2 years post injury, so I would not assume that he will remain an ASIA A.

    Did he get a comprehensive rehabilitation program? How independent is he at this point?

    You may want to post on the Cure forum about stem cell therapy, but I know of no program that is providing a cure via this route, and many have spent significant funds on this without any significant improvement. You may, at this point, get more benefit by assuring that he has appropriate rehabilitation and equipment to increase his function and ability to live an active community life.

    Can you get him on-line to join our community directly?

    (KLD)

  3. #3

    Sponataneous Intra dural heamatoma leading to paraplegia

    cross posting to this forum as advised by the new SCI moderatorMy 66yr old father developed a sudden pain in his thoracolumber region with paraplegia and bowel bladder involvement with sensory level D6.His MRI spine was suggestive of a large intradural haematoma D1-D10 emergency surgery for exploration, evacuation of haematoma with D2-D9 laminoplasty,Spinal cord was healthy and pink. Post op MRI revealed adequate spinal canal decompression with extensive area of altered cord signal at dorsal level s/o myelomalacia. He is an ASIA A .Sensory level D8 motor 0 sensory 0 paraplegia with bowel, bladder involvement.

    We are willing to explore stem cell therapy as we are hopeful of his recovery.We live in India. If anyone has any info which can be of help pl let me know. Its now four months since this incident.

    We are worried that there could a relapse of the incident. No cause of the bleeding was found. Could an invasive MRI determine any AVMs? Can something be done to prevent another mishap?

    Thanks.

    Vandana

  4. #4
    Hi SCi-Nurse,
    Thanks for your reply.

    His spontaneous haematoma occured 4 months back. His rehab is continuing. He's still not very independent. He's still on diapers as his bowel is still not settled into a regime. There is leaking in between two CIC due to which he needs to be on condom drainage. If he's able to get these two under control his quality of life would improve. Please help.

  5. #5
    Dr. Wise,

    My healthy 66yr. old father developed intra dural bleed and became a paraplegic in front of my eyes.Post surgery there has been no improvement. Past 4 months have been traumatic it was a bolt from the blue. As his spinl cord was 'pink and healthy' according to his neurosurgeon i feel he stands to gain from stem cell therapy.
    Please comment.

  6. #6
    Senior Member
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    Quote Originally Posted by Vandana
    We are worried that there could a relapse of the incident. No cause of the bleeding was found. Could an invasive MRI determine any AVMs? Can something be done to prevent another mishap?

    Thanks.

    Vandana
    Hello Vandana. To further exam this above MRI which could spot AVM’s depending on size, is superselective angiography (Link here), which could be a normal route I believe, did he have that procedure before or after the surgery? That procedure could map out the tiniest capillaries to determine if the AMV was completely surgically removed and also being used later on for follow-up examinations to monitor any not wanted re-growth of the AVM. Good luck to you and your dad.

  7. #7
    Is he in a SCI rehab program or a nursing home? We need to know much more.

    Diapers are not appropriate. He should be on a bowel program that controls when he has a bowel movement, and doesn't have to worry about having a bowel movement at other times.

    At the very least, download this booklet about bowel care, read it cover to cover, and insist that his caregivers and doctor follow the suggested program: Neurogenic Bowel: What you should know

    Has he had urodynamics? This is needed to determine how to control his bladder. Medications should be used to prevent both high pressures and leakage between his intermittent catheterizations. You should also download and share with his physician the clinical practice guideline titled Bladder Management for Adults with Spinal Cord Injury, which is also on the page linked above.

    Is his doctor a specialist in spinal cord injury rehab???

    (KLD)

  8. #8
    Quote Originally Posted by Vandana
    cross posting to this forum as advised by the new SCI moderatorMy 66yr old father developed a sudden pain in his thoracolumber region with paraplegia and bowel bladder involvement with sensory level D6.His MRI spine was suggestive of a large intradural haematoma D1-D10 emergency surgery for exploration, evacuation of haematoma with D2-D9 laminoplasty,Spinal cord was healthy and pink. Post op MRI revealed adequate spinal canal decompression with extensive area of altered cord signal at dorsal level s/o myelomalacia. He is an ASIA A .Sensory level D8 motor 0 sensory 0 paraplegia with bowel, bladder involvement.

    We are willing to explore stem cell therapy as we are hopeful of his recovery.We live in India. If anyone has any info which can be of help pl let me know. Its now four months since this incident.

    We are worried that there could a relapse of the incident. No cause of the bleeding was found. Could an invasive MRI determine any AVMs? Can something be done to prevent another mishap?

    Thanks.

    Vandana
    Vandana,

    I am sorry that I did not see your post earlier. Does your father have a predisposing reason for the hemorrhage, such as anti-coagulation therapy? It is rather unusual for such an extensive hemorrhage to occur without a reason. The main reason for asking is of course to find ways of avoiding recurrence in the future.

    You do not say how long it took for for the decompression to occur but I am concerned that it may have caused an extensive infarct in the spinal cord. In most subdural hemorrhages, rapid evacuation of the hematoma results in some return of function. This is of course why an emergency evacuation procedure is strongly recommended.

    The fact that he has a D8 (T8) level now suggests that he has a thoracic cord injury. Does he have any spasticity in his legs? The reason why I ask is to ascertain the degree of gray matter damage. If he has no spasticity (and is not taking any anti-spasticity drugs), this would suggest that he has gray matter damage in the lumbosacral cord.

    Regarding recovery, has he been recovering? Your father is still relatively early after the injury. A majority of people show both motor and sensory recovery for a year or more after injury. Is he getting physical and other therapies, including standing exercises and functional electrical stimulation?

    Regarding "stem cell therapies", there is no evidence that stem cell therapies at the present will help in a situation such as your father. In my opinion, most of so-called "stem cell therapies" that are being offered in various clinics and hospitals in India are not proven therapies and are being provided by doctors who have little or no experience with spinal cord injury.

    There are a many good neurosurgeons in India. Alok Sharma and Kiki Turel in Bombay are among the best. I would trust their opinions.

    Wise.

  9. #9
    Quote Originally Posted by Wise Young
    Vandana,

    I am sorry that I did not see your post earlier. Does your father have a predisposing reason for the hemorrhage, such as anti-coagulation therapy? It is rather unusual for such an extensive hemorrhage to occur without a reason. The main reason for asking is of course to find ways of avoiding recurrence in the future.

    You do not say how long it took for for the decompression to occur but I am concerned that it may have caused an extensive infarct in the spinal cord. In most subdural hemorrhages, rapid evacuation of the hematoma results in some return of function. This is of course why an emergency evacuation procedure is strongly recommended.

    The fact that he has a D8 (T8) level now suggests that he has a thoracic cord injury. Does he have any spasticity in his legs? The reason why I ask is to ascertain the degree of gray matter damage. If he has no spasticity (and is not taking any anti-spasticity drugs), this would suggest that he has gray matter damage in the lumbosacral cord.

    Regarding recovery, has he been recovering? Your father is still relatively early after the injury. A majority of people show both motor and sensory recovery for a year or more after injury. Is he getting physical and other therapies, including standing exercises and functional electrical stimulation?

    Regarding "stem cell therapies", there is no evidence that stem cell therapies at the present will help in a situation such as your father. In my opinion, most of so-called "stem cell therapies" that are being offered in various clinics and hospitals in India are not proven therapies and are being provided by doctors who have little or no experience with spinal cord injury.

    There are a many good neurosurgeons in India. Alok Sharma and Kiki Turel in Bombay are among the best. I would trust their opinions.

    Wise.
    Dear Dr.Wise

    Thanks for your reply.I sincerely appreciate. Sorry for my late response.

    In Jan. this year my father had high fever and cough with breathlessness. CXray revealed Lt. lower lobe Pneumonia.On third night of his hospital stay he complained of a sharp shooting pain in the back of his head going down the back. Subsequently he complained of numbness and loss of movement in lower limbs.By the time the doctors realised that it was spinal cord trauma,MRI was done,he was taken for emergency surgery-we had lost 16 hours (for decompression).

    The neurosurgeon said his tissues were 'oozing' more than normal during surgery.Post op his haematologist went through old haemograms and could'nt find any anamoly though he asked us to get coagulation study done(we have to get it done).

    Spasticity- beginning in rt. leg and present in lt. leg.
    Post injury there has been no recovery.He goes for rehabilitation to indian spinal injuries centre (New Delhi)where he does various activities including standing frame but no FES as they don't have one.
    He is on diapers and does CIC.His urodynamics have been performed,he has leaks in between CIC and needs condom catheter.

    Its been 4 1/2months since trauma.

    1.Should we get a coagulation study done on him?
    2.To rule out another episode what would you suggest?
    3.As his upper body has to bear all the load both his shoulders have pain and he has resticted movement,pain is acute in the night.Orthopedic surgeon says wear and tear of cartilage and has prescribed glucosamine
    with msm for repair.
    Your input is extremely valuable and this site has been very informative.
    Thanks so much.
    Vandana.

  10. #10
    Quote Originally Posted by Leif
    Hello Vandana. To further exam this above MRI which could spot AVM’s depending on size, is superselective angiography (Link here), which could be a normal route I believe, did he have that procedure before or after the surgery? That procedure could map out the tiniest capillaries to determine if the AMV was completely surgically removed and also being used later on for follow-up examinations to monitor any not wanted re-growth of the AVM. Good luck to you and your dad.
    Hello Lief,
    Thanks for your input I appreciate it.Sorry for my late reply.

    My father's had two MRI which couldn't detect an AVM.I'll ask his Doc. about superselective MRI and MRA too.The link on AVM was very informative and I learnt a lot from it.
    I'm grateful for all the support and look forward to sharing more.
    Thanks again.
    Vandana.

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