Transient Paraparesis from a Traumatic Lumbar Intrathecal Hemorrhage. A Case Report and Literature Review
|Walsh KM1*, Vedant V2 and Schlenk RP1,2|
|1Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA|
|2Center for Spine Health, Cleveland Clinic, Cleveland Ohio, USA|
|Corresponding Author :||Walsh KM
Department of Neurosurgery
Cleveland Ohio, USA
E-mail: [email protected]
|Received date: November 05, 2015; Accepted date: January 06, 2016; Published date: January 08, 2016|
|Citation: Walsh KM, Vedant V, Schlenk RP (2016) Transient Paraparesis from a Traumatic Lumbar Intrathecal Hemorrhage. A Case Report and Literature Review. J Neurol Disord 4:254. doi:10.4172/2329-6895.1000254|
|Copyright: © 2016 Kevin, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
Background: Intrathecal bleeding can be subdural, subarachnoid or intramedullary depending on its location. Intrathecal bleeding within the lumbar spine is seldom reported and no specific guidelines for its diagnosis and management exist. We present a case of transient paraparesis secondary to a post-traumatic lumbar intrathecal hemorrhage, which resolved spontaneously without surgical intervention.
Case description: The patient is a 66-year-old male with a PMH of chronic myelomonocytic leukemia (CMML) who underwent two lumbar punctures during the workup for newly diagnosed intracranial lesions. The patient shortly thereafter began to complain of acute onset lower extremity weakness. An MRI revealed a large ventral lumbar intrathecal hemorrhage, extending from T11 to the sacrum with canal compromise. The decision was made, after much discussion, to manage the patient conservatively without surgery. Over the course of his hospital stay, the patient’s leg strength significantly improved, and as of his three-month follow up visit, his strength was nearly back to baseline.
Conclusions: Bleeding episodes in the spine are usually epidural and most case reports have shown that in the presence of neurological deficit or deterioration, surgical evacuation is the recommended treatment. However in patients with intrathecal hemorrhage, conservative management is a viable option, especially in high-risk surgical candidates.