Evolución neurológica en la lesión medular traumática en función del tamaño de la hemorragia intraparenquimatosa

Introduction and objectives

The presence of spinal cord hemorrhage is considered as a poor prognostic factor in traumatic spinal cord injury (SCI). However, it has been suggested in published works that the prognosis of small hemorrhages is not so negative. The aim of this paper is to assess the neurological evolution in individuals with intraparenchymal hemorrhage according to its size.

Material and methods

Retrospective observational study. Selected all the patients admitted for acute traumatic SCI between 2010 and 2018 with early magnetic resonance study and spinal cord hemorrhage. Two groups were established depending on the size of the bleeding: microhemorrhages (less than 4 mm) and macrohemorrhages (greater than 4 mm). The neurological examination at admission and discharge was compared according to the AIS grade and the motor score (MS).

Results

Forty-six cases collected, 17 microhemorrhages and 29 macrohemorrhages. 70.6% of the microhemorrhages were AIS A while among macrohemorrhages the percentage was 89.6%. At the time of discharge, an improvement in the AIS grade was observed in 40.0% of the microhemorrhages compared to 4.0% of the macrohemorrhages (P=.008). Initial MS was similar, 45.2 ± 22.2 in the microhemorrhages and 40.9 ± 20.4 in the macrohemorrhages (P=.459), but at discharge it was higher in the first group: 60.4 ± 20.5 for 42.7 ± 22.8 (P=.033). Eight patients (17.4%) died during admission.

Conclusions

There is a relationship between the size of the intraparenchymal hemorrhage and the neurological prognosis of SCI, with hemorrhages smaller than 4 mm presenting a better evolution.