title: Idiopathic Spontaneous Intramedullary Hemorrhage: A Report of a Rare Case of Repeated Intramedullary Hemorrhage with Unknown Etiology.
abstract: A 48-year-old woman presented with acute voiding difficulty, numbness and weakness of both lower extremities. Magnetic resonance imaging (MRI) showed an intramedullary hemorrhagic mass that extended from T9 to T10. T8-T10 laminotomy and surgical removal of the hemorrhagic mass was performed. The pathological diagnosis was hematoma. Her neurological status remained the same after the operation. At 5 days post-operation, the patient suddenly became paraplegic, and MRI that was immediately performed revealed a recurrent intramedullary hemorrhage. Emergent surgical evacuation was performed. Again, histological examination showed only hematoma, without any evidence of abnormal vessels or a tumor. A postoperative MRI revealed no abnormal lesions other than those resulting from postoperative changes. At a 9-month follow up, the patient could walk a short distance with the aid of a walker. Because spontaneous intramedullary hemorrhage with unknown etiology is very rare, it is essential to perform a meticulous inspection of the hemorrhagic site to find the underlying cause. Repeated hemorrhage can occur; therefore, close observation of patients after surgery is important in cases without an apparent etiology. Urgent surgical evacuation is important to improve outcomes in these cases.
authors.affiliation: Department of Neurosurgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
authors.forename: Byeong Sam
authors.initials: BS
authors.lastname: Choi
authors.affiliation: Department of Neurosurgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
authors.forename: Sungjoon
authors.initials: S
authors.lastname: Lee
keywords: Hematomyelia; Idiopathic; Intramedullary hemorrhage; Intraspinal hemorrhage; Spinal cord; Spontaneous
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