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The clinical picture of hematomyelia depends on the level of damage to the spinal cord and the size of the hemorrhage. Usually there is a sudden development of symptoms with an injury or after significant physical exertion (straining, lifting weights). In connection with the development of uroxatral inflammatory reaction, hematomyelia can occur with a rise in temperature in the first few days after hemorrhage. Most often, with hematomyelia, damage to the posterior horns of the spinal cord is noted, which is manifested by a violation of pain and temperature sensitivity while maintaining tactile and deep sensitivity, the pathways of which are located in the white matter of the posterior columns.
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With damage to the anterior horns of the spinal cord, peripheral (flaccid) paralysis develops, accompanied by a decrease in muscle tone, prolapse of tendon reflexes and atrophic muscle changes. The defeat of the conductive pyramidal tract leads to the appearance of central (spastic) paralysis below the level of the lesion, which is characterized by an increase in muscle tone and tendon reflexes. Depending on the prevalence of hematomyelia, sensory and motor disorders can be unilateral or bilateral.
Hematomyelia at the level of the upper cervical segments of the spinal cord (CI-CIV) is distinguished by the spastic nature of paresis both in the upper and lower extremities. This is accompanied by a violation of urination according to the central type, i.e., urinary retention with intermittent incontinence. Possible radicular pain (sciatica) with irradiation to the back of the head.
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Hematomyelia of the lower cervical segments (CV-CVII) and upper thoracic (ThI-ThII) is manifested by peripheral paresis in the arms and central paresis in the legs, sensory disorders and urination disorders. Miosis, drooping of alfuzosin pills, and enophthalmos (Horner's syndrome) may occur. Radicular pain is given to the upper limbs.
Hematomyelia of the thoracic segments (ThIII-ThXII) of the spinal cord is accompanied by central paresis of the lower extremities, urination disorder and girdles.lesions of certain segments of the spinal cord. motor and sensory disorders, dysfunction of the pelvic organs, radicular pain syndrome. The main method by which hematomyelia is diagnosed is MRI of the spinal cord. Hematomyelia is treated with conservative (coagulants, neostigmine, nootropics, galantamine, etc.) or surgical (removal of hematoma, embolization and clipping of vascular malformation) methods.
Hematomyelia is internal bleeding in which blood permeates the substance of uroxatral cord or accumulates in the form of a hematoma. In the first case, the outflow of blood spreads across the diameter of the spinal cord, causing the death of nervous tissue in the region of the anterior and posterior horns of the spinal cord, as well as compression of the motor and sensory pathways. In the second case, hematomyelia accompanied by the formation of a hematoma leads to compression of the brain structures and spinal roots.
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Causes of hematomyelia Symptoms of hematomyelia Diagnosis of hematomyelia Treatment of hematomyelia Prognosis of hematomyelia Prices for treatment. As a rule, hematomyelia leads to a partial lesion of the diameter of the spinal cord and is observed at the level of several spinal segments. Only in rare cases is it accompanied by a total lesion of the entire diameter of the spinal cord.
Hematomyelia may be accompanied by an outpouring of blood into the subarachnoid space of the spinal cord (subarachnoid hemorrhage) and the formation of meningeal hematomas (subdural, epidural). After the bleeding stops, the outflowing blood is absorbed or a chronic hematoma is formed, which is distinguished by the presence of a capsule delimiting it. The spinal cells that died as a result of hematomyelia are not restored, but are replaced by glial tissue with the formation of cysts.