Hemorrhage spinal

In the presence of an intraspinal hemorrhage spinal vascular malformation, cavernoma, coagulopathy and tumor have to be differentiated. 

The vasoconstrictor actions of epinephrine and norepinephrine have been used to prolong the action of local anesthetics by reducing local blood flow in the region of the injection. Epinephrine has been used as a topical hemostatic agent for the control of local hemorrhage. Norepinephrine is infused intravenously to combat systemic hypotension during spinal anesthesia or other hypotensive conditions in which peripheral resistance is low, but it is not used to combat the hypotension due to most types of shock. In shock, marked sympathetic activity is already present, and perfusion of organs, such as the kidneys, may be jeopardized by norepinephrine administration. 

Embolism from thrombus within the cavity of an aneurysm is rare and is difficult to prove in cases where there maybe other potential sources of embolization. Intracranial aneurysms more commonly present with rupture and subarachnoid hemorrhage, whereas internal carotid artery aneurysms tend to cause pressure symptoms including a pulsatile and sometimes painful mass in the neck or pharynx, ipsilateral Horner s syndrome or compression of the lower cranial nerves. Extracranial vertebral artery aneurysms may cause pain in the neck and arm, a mass, spinal cord compression and upper limb ischemia (Catala et al. 1993). 

Spinal subarachnoid hemorrhage is very rare. It is caused by a vascular malformation, hemostatic failure, coarctation of the aorta, inflammatory vascular disease, mycotic aneurysm or a vascular tumor such as ependymoma. Accumulating hematoma may compress the spinal cord. Suspicion is aroused if the cerebral angiogram is negative and the patient develops spinal cord signs. 

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