Spinal Hemorrhage Leading to Cerebral Vasospasm and Infarction

Abstract

Only one case of intracranial arterial vasospasm resulting cerebral infarction was previously described in the setting of spinal hemorrhage. The speculation of such symptomatic vasospasm being caused by an intracranial extension of the spinal hemorrhage has been unproven. Here we describe two patients with extensive spinal hemorrhage demonstrated on spinal magnetic resonance imaging (MRI). During their subsequent course, both patients developed cranial signs that included encephalopathy, visual deficit and aphasia. In both cases, small amount of intracranial hemorrhage was detected on head imaging, representing an extension of the spinal hemorrhage. Multiple areas of acute ischemia were seen on brain MRI in both patients. On digital subtraction angiography, diffuse vasospasm of carotid and vertebrobasilar arteries was seen which became normalized prior to discharge. Our report suggests that in treating patients with spinal hemorrhage, physicians need to be aware of possible intracranial hemorrhagic extension and subsequent cerebral vasospasm leading to ischemia. As symptoms of intracranial origin are commonly seen in patients with spinal hemorrhage, the incidence of cerebral vasospasm in this setting could be underestimated.