Spinal subarachnoid hematoma

Case contributed by Dr John Duignan

Presentation

Twelve hours of progressive lower limb weakness, saddle anaesthesia and urinary incontinence.

Patient Data

Age: 70 years
Gender: Male
MRI

MR of the lumbosacral spine demonstrates subarachnoid T2 hypointensity. This subarachnoid abnormality is T1 isointense to the spinal cord. There is severe compression of the cauda equina. The appearances are consistent with a subarachnoid hemorrhage.

Case Discussion

A 70-year-old male presented with twelve hours of progressive lower limb weakness, saddle anesthesia and urinary incontinence. He had undergone a diagnostic lumbar puncture three days previous to the onset of symptoms. The lumbar puncture was performed as part of a diagnostic workup of progressive bulbar symptoms.

MR of the lumbosacral spine was performed. This demonstrated subarachnoid T2 hypointensity extending from the L3 vertebral body level to the filum terminale (see sagittal and axial T2 sequences). This subarachnoid lesion is T1 isointense to the spinal cord. There is severe compression of the nerve roots at this level. The appearances are consistent with an acute spinal cord subarachnoid hemorrhage with an associated cauda equina syndrome.

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Case information

rID: 62678
Published: 12th Sep 2018
Last edited: 23rd Oct 2018
Inclusion in quiz mode: Included
Institution: St Vincent's University Hospital

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