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Thread: Spinal cord bleed

  1. #1

    Spinal cord bleed

    In October, 2007, my 73 year old mother suffered a spinal cord bleed. She had a laminectomy from the T-1 to Y-3 level but had fluid through to the T-5 level, with abnormal signal (?) extending from T-6 to T-12. This is an incomplete injury. Will she get better or worse as the rest of this fluid dissipates? She cannot stand or walk, but has mobility in her legs. She is also incontinent, I catherize her twice a day now. She has regained feeling and mobility in her right leg since she left her rehab hospital, which greatly encouraged us, but seems to stayed the same since. Also, will there be any way eventually to retrain her bladder so that she doesn't need to be changed every couple of hours? It makes it so difficult to go places for any length of time.
    Susan

  2. #2
    Welcome to our forums. Please ask any questions...we will try to help.

    Spinal cord bleeds can vary greatly in how much return the person gets...from none at all to significant return. It is very individual, but youth does make a difference. When you say fluid, I assume you mean blood clot? The normal fluid (CSF) around the cord should not go away. It is there for a purpose.

    Did she go to a major SCI rehab center for rehab?

    You cannot "train" body organs like the bladder. It would be best to look at one of two options for bladder management at this point:
    1. Catheterize her 5-6X daily, and have her urologist use medications to prevent leakage or incontinence in between. These meds have a lot of side effects and some older people have more problems with these side effects.
    2. Consider going to an indwelling (Foley) catheter 24/7. A leg bag can be worn during the day under clothing to allow her to go out in public with minimal problems.
    Does she have a good SCI or neurologic specialty urologist?
    Does she have a good SCI-specialist physiatrist?

    (KLD)

  3. #3
    Quote Originally Posted by susan s
    In October, 2007, my 73 year old mother suffered a spinal cord bleed. She had a laminectomy from the T-1 to Y-3 level but had fluid through to the T-5 level, with abnormal signal (?) extending from T-6 to T-12. This is an incomplete injury. Will she get better or worse as the rest of this fluid dissipates? She cannot stand or walk, but has mobility in her legs. She is also incontinent, I catherize her twice a day now. She has regained feeling and mobility in her right leg since she left her rehab hospital, which greatly encouraged us, but seems to stayed the same since. Also, will there be any way eventually to retrain her bladder so that she doesn't need to be changed every couple of hours? It makes it so difficult to go places for any length of time.
    Susan
    Susan,

    Do you remember whether the spinal cord hemorrhage was subdural or epidural. I assume that it was in the spinal cord as opposed to outside the spinal cord and pressing on it. The reason why I ask is because intraspinal bleeds tend to have a worse prognosis. It was unclear from your description.

    MRI's usually detect increased water concentration in the tissue. When tissues are damaged, they have increased water content in the tissue and therefore there is usually increased signal. I assume that they operated on her and removed whatever blood that they could find. The fact that the abnormal signal went all the way to T12 suggests that there may have been some damage below T3.

    Do you remember when the surgery was done relative to when she had her symptoms. Was she taking an anti-coagulant? This is the most common cause of a spinal bleed. In the days after the bleed, was she able to move her legs at all or have feeling in them? Did you have feeling in her anus? If she did not have movement in the legs and no feeling in the anus during the first few days after injury, this usually has a worse prognosis.

    The fact that she recovered some right leg function is a good and hopeful sign. Most people do not complete their recovery for at least a year after injury and often longer. So, it is likely that she will recover more. What kind of rehabiitation is she getting and how much ambulation training is she getting? This is an essential part of recovering the legs. Can she feel her bladder when it is full? Can she feel her anus now?

    Wise.

  4. #4
    Wise, the spinal cord bleed was caused by an anti-coagulant. It was not diagnosed for approx. 9 days, surgery was done then. The report said it was either epidurally or intradurally. The procedure was Posterior right sided T1, T2, T3 laminectory/hemilaminectomy for decompression of the spinal cord.
    Immed after surgery she could move her left leg, not the right. No feeling in anus. She went to a good rehab hospital in PA, and about a week after coming home got mobility and feeling in her right leg. She cannot feel when her bladder is full, but sometimes can feel when she has urinated and passed stool.
    Right now, she is in out patient rehab. She is having some issues with her right knee (bursitis) and has lost some strength because of the time lost.
    She did go to a urologist who suggested intermittent cathereterization 2-3 times a day, and thought it would be difficult to manage the incontinence, and that possibly she may eventually do well on Detrol-LA.
    Susan

  5. #5
    I see. Thanks. Based on your description, I am very hopeful that she will regain more function. It sounds like an epidural hemorrhage. It would have been better of course if it had been detected and decompressed earlier but it suggests that it was probably a slowly increasing compression and these usually do well. The absence of anal sensation is consistent with poor bladder sensation but it may still come back. It is good that she had rapid return of some function after the decompression. Her right knee bursitis (which would make the leg weak because the pain induces flexor reflexes when she uses the leg to bear weight) may be the reason why she is not as much progress on the right leg. She may want to consider more hydrotherapy (swimming) which will allow her to move her legs without weight bearing. Summer is coming and it is something that can be done with family and friends. Finally, it is still less than a year after her injury. She should recover more, hopefully including her bowel and bladder.

    Wise.

    Quote Originally Posted by susan s
    Wise, the spinal cord bleed was caused by an anti-coagulant. It was not diagnosed for approx. 9 days, surgery was done then. The report said it was either epidurally or intradurally. The procedure was Posterior right sided T1, T2, T3 laminectory/hemilaminectomy for decompression of the spinal cord.
    Immed after surgery she could move her left leg, not the right. No feeling in anus. She went to a good rehab hospital in PA, and about a week after coming home got mobility and feeling in her right leg. She cannot feel when her bladder is full, but sometimes can feel when she has urinated and passed stool.
    Right now, she is in out patient rehab. She is having some issues with her right knee (bursitis) and has lost some strength because of the time lost.
    She did go to a urologist who suggested intermittent cathereterization 2-3 times a day, and thought it would be difficult to manage the incontinence, and that possibly she may eventually do well on Detrol-LA.
    Susan
    Last edited by Wise Young; 03-20-2008 at 08:51 AM.

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