Spinal Cord Hemorrhage and Bleeding

The spinal cord is made up of very sensitive tissues. Any damage, injury, or pressure on the spinal cord can cause serious damage, including the possibility of permanent paralysis. Bleeding in and around the spinal cord can be caused by trauma, medical errors, or other health conditions. Spinal cord hemorrhage can cause serious injury and must be treated quickly to reduce the risk of permanent injury. 

If a doctor negligently caused spinal cord bleeding or failed to properly treat a spinal cord hemorrhage, the injury victim may have a claim for damages. Contact your medical malpractice attorney to understand your rights. 

Spinal Cord Hemorrhage and Bleeding

The spinal cord is surrounded by layers of meninges, or tissue around the central canal. These three membrane layers include the dura mater, arachnoid mater, and pia mater. When bleeding occurs between the layers and causes a hematoma, it can increase pressure in the spinal cord and block the cerebrospinal fluid (CSF). This can prevent neural transmissions between the brain and the rest of the body, causing pain, weakness, and paralysis. 

The spinal cord, like other tissues, needs a regular supply of oxygenated blood to function properly. The blood is supplied to the spinal cord through the vertebral canal. The arterial blood supply to the spinal cord comes from different areas depending on the region of the spinal cord. The primary supply of blood comes from the single anterior spinal artery and two posterior spinal arteries. 

The superior and inferior articular processes connect to form the intervertebral foramen, through which the blood vessels and nerves enter and exit the spinal cord. The spinal cord drains blood through the anterior and posterior spinal veins, which drain into the internal vertebral venous plexus in the epidural space.  

A spinal cord hemorrhage is a rare but serious condition where bleeding affects the spinal cord. Spinal cord hemorrhage can be divided based on where it occurs, including: 

  1. Intramedullary hemorrhage (hematomyelia),
  2. Subarachnoid hemorrhage (SAH),
  3. Subdural hemorrhage (SDH), and 
  4. Epidural hemorrhage (EDH).

Intramedullary Hemorrhage or Hematomyelia

Intramedullary hemorrhage is bleeding within the spinal cord. This is most often caused by trauma, such as a car accident, fall, gunshot wound, or other blow to the spinal column. However, there may be nontraumatic causes of hematomyelia, including: 

  • Vascular malformations
  • Tumors
  • Bleeding disorders (such as hemophilia and von Willebrand disease)
  • Syphilis
  • Syrinx
  • Myelitis

It can be difficult to diagnose intramedullary hemorrhage because it is rare and has varied presentations. Considerations may include anticoagulants like warfarin or heparin, hereditary bleeding disorders, or spinal cord tumors. Symptoms may include sudden and severe back or neck pain. When a doctor recognizes myelopathy syndrome (compression of the spinal cord), magnetic resonance imaging (MRI) may show the location of a hematoma. 

When bleeding occurs in the spinal cord, compression decreases blood flow to the surrounding tissue. A cascade of events can ultimately cause spinal cord injury which continues hours or even days after the initial bleed. Treatment options can include surgery to remove the build-up of blood and fluid, to remove the pressure on the spinal cord. Treatment also involves addressing the underlying cause of the hemorrhage. 

Subarachnoid Hemorrhage (SAH)

The spinal subarachnoid space is the space between the arachnoid mater and the pia mater. Subarachnoid hemorrhage in the spine can be caused by trauma, lumbar punctures, vascular lesions, arteriovenous malformations, arteriovenous fistula, neoplastic lesions, coagulopathy, systemic lupus, or other conditions that cause bleeding into the subarachnoid space in the spinal cord. 

With no history of trauma, bleeding disorders, or anticoagulant drugs, it can be difficult to diagnose SAH. Imaging with an MRI can show an area of mass in the spinal cord where the bleeding is putting pressure on the spinal cord and impairing blood flow. The area of the spinal cord with the hematoma may influence where the pain or paralysis occurs in the body. Treatment may include surgery or where the mass is diminishing, conservative management may see the hematoma resolve on its own. 

Subdural Hemorrhage (SDH)

The subdural space in the spine is the area between the arachnoid mater and the dura mater. Hemorrhage in this area is rare because the space does not contain any bridging veins. In spinal hematomas, only a small percentage involve subdural hemorrhage. When bleeding does occur in the subdural space, it can compress the spine and impair blood flow. 

Symptoms of a subdural hemorrhage are like other symptoms of spinal cord compression or cauda equina syndrome, namely back pain or radicular pain. Causes can include spinal vascular formations, back surgery, blood disorders, anticoagulant therapy, or percutaneous spinal intervention. 

Epidural Hemorrhage (EDH)

A spinal epidural hemorrhage can cause a build-up of blood in the extradural neural axis compartment. The space contains veins and nerves. Bleeding in the area can decrease blood supply to other areas and put pressure on the nerves and spinal cord, which can lead to spinal cord damage. 

The symptoms of a spinal epidural hemorrhage will depend on the location of the hematoma, and generally includes severe pain and neurological deficit. Causes can include bleeding disorders, over-anticoagulation, trauma, puncture, tumors, or spinal arteriovenous malformations.  

Spinal Cord Injury Caused by Hemorrhage

A spinal hemorrhage can cause serious or permanent spinal cord damage. The extent of the damage can depend on a number of factors, including where on the spinal cord the hematoma occurred, in which space or layer the hemorrhage occurred, the pressure of the edema, and length of time. Injury can include: 

  • Paralysis, 
  • Bladder dysfunction, 
  • Bowel dysfunction,
  • Walking impairment, 
  • Weakness, 
  • Pain, and
  • Sexual dysfunction.

Medical Malpractice in Spinal Cord Bleeds

Spinal cord hematoma can be caused by medical mistakes. When a doctor does not follow the standard of care of others in their profession, it can have disastrous consequences, including permanent paralysis. When a doctor is to blame for a spinal cord injury, they should be held accountable and made to pay for the cost of living with a permanent spinal injury. Some of the most common causes of spinal cord bleeds that are related to medical malpractice include: 

Spinal Cord Hemorrhage Malpractice Attorneys

It can be difficult to find out if a spinal cord injury was caused by medical malpractice. At Gilman & Bedigian, we will use our experience, knowledge, and dedication to investigate medical accidents to determine who is to blame for your injuries. Our aggressive trial lawyers have helped our clients recover millions of dollars in compensation related to spinal cord injuries caused by medical error. Contact us online or call our law office at (800) 529-6162 for a free consultation.

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