Hemorrhage into the Spinal Cord.
Synonyms.—Spinal Apoplexy; Hematomyelia.
Definition.—A hemorrhage directly into the substance of the cord.
Etiology.—Spinal apoplexy may be due to traumatism, to changes in the coats of the blood-vessels, or to excessive blood-pressure.
Pathology.—The clot may be as large as an almond, seldom larger, the appearance of which depends upon its age; if recent, it will be red or dark in color, and changes to brown or yellow with age; still later it may become encapsuled by a fibrous deposit. There may be gliomatous tumors or acute myelitis.
Symptoms.—The symptoms depend somewhat upon the seat of the lesion and the extent of the hemorrhage. Where the hemorrhage is large, severe shooting pains occur in the back and limbs, with muscular twitchings, cramps, and rigidity. Usually the pain in the back is severe, subsiding within twenty-four hours. Paraplegia is sudden, with loss of sensation and the reflexes, and not infrequently loss of control of the bladder and bowels.
The type of paralysis may be monoplegia, hemiplegia, or paraplegia. Disturbance of the sensory functions may give rise to hyperesthesia, anesthesia, paresthesia, etc.
Diagnosis.—The diagnosis is always difficult, the difference between the symptoms of hematomyelia and hematorrachis being so slight as to render a positive diagnosis almost impossible.
Prognosis.—This depends upon the extent and location of the clot. Thus hemorrhage into the dorsal segments is less serious than in the cervical or lumbar segments, respiration being disturbed in the former through interference with the phrenic nerve, and the vesical and rectal sphincters in the latter.
If the hemorrhage be small in quantity, absorption may speedily take place with complete recovery. The rapid development of bed-sores is an unfavorable symptom.
Treatment.—The same line of treatment as used in spinal-meningeal hemorrhage, can be carried out in this lesion.