Walsh KM, Vedant V and Schlenk RP
Background: Intrathecal bleeding can be subdural, subarachnoid or intramedullary depending on its location. Intrathecal bleeding within the lumbar spine is seldom reported and no specific guidelines for its diagnosis and management exist. We present a case of transient paraparesis secondary to a post-traumatic lumbar intrathecal hemorrhage, which resolved spontaneously without surgical intervention.
Case description: The patient is a 66-year-old male with a PMH of chronic myelomonocytic leukemia (CMML) who underwent two lumbar punctures during the workup for newly diagnosed intracranial lesions. The patient shortly thereafter began to complain of acute onset lower extremity weakness. An MRI revealed a large ventral lumbar intrathecal hemorrhage, extending from T11 to the sacrum with canal compromise. The decision was made, after much discussion, to manage the patient conservatively without surgery. Over the course of his hospital stay, the patient’s leg strength significantly improved, and as of his three-month follow up visit, his strength was nearly back to baseline.
Conclusions: Bleeding episodes in the spine are usually epidural and most case reports have shown that in the presence of neurological deficit or deterioration, surgical evacuation is the recommended treatment. However in patients with intrathecal hemorrhage, conservative management is a viable option, especially in high-risk surgical candidates.
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