Hemorrhage into the Spinal Membrane.
Synonyms.—Meningeal Apoplexy; Hematorrachis.
Definition.—Extrameningeal hemorrhage is where the blood is between the dura mater and the spinal canal. Intrameningeal hemorrhage, is where the bleeding takes place between the dura mater and the pia mater.
Etiology.—Most meningeal hemorrhages are due to violence, resulting in injuries, as from blows or falls. The rupture of an aneurism is sometimes responsible for this condition. Cancer may give rise to hemorrhage by erosion of the blood-vessels. Diseases attended by severe convulsion have also figured as causal factors. It may occur as a complication of any of the infectious fevers. Cerebral hemorrhage may result in extravasation of blood into the membranes of the cord. Males are more apt to suffer than females, no doubt owing to greater exposure.
Pathology.—The peridural space accommodates quite a large amount of blood without resulting in pressure, hence large hemorrhages are found in the extrameningeal form.
In the intrameningeal form the hemorrhages are small and scattered.
Symptoms.—If the hemorrhage be small the symptoms are negative, but if large enough to produce pressure, are apoplectiform in character although consciousness is retained.
The first effect is irritation and hyperesthesia, muscular irritability, radiating neuralgic pains, and herpes follow. Later, however, the pain ceases, and anesthesia and paralysis follow. The bladder and rectum may share in the lesion, incontinence being the distressing feature. Where the hemorrhage is high, respiration is involved.
Diagnosis.—This is generally difficult, a positive diagnosis being seldom made.
Prognosis.—This depends largely upon the amount of the hemorrhage and the causes giving rise to it. If the hemorrhage be small and the general health good, absorption rapidly takes place, with complete-recovery.
Treatment.—The treatment will be that used for hemorrhage of any part or organ. Rest in bed, cold applications, and the internal administration of gallic acid, ergot, the oils of cinnamon and erigeron, mangifera indica, and others of like character. Massage, electricity, and the iodids will be used to promote absorption.