Spinal Subarachnoid Hemorrhage Associated with Spinal Ischemic Stroke in the Thoracic Region of the Spinal Cord – A Case Report

We present a case report of a 69-year old man with spinal ischemic stroke and spinal subarachnoid hemorrhage (sSAH) in the thoracic region. The first complaint was low back pain, which was followed by retention of urine, inferior paraplegia and distal hypesthesia below Th7-8 dermatome. The diagnosis was confirmed by lumbar puncture, which showed xanthochromic cerebrospinal fluid with erythrocyte- and proteinrachia, and contrast MRI of thoracic region, the latter visualizing two lesions. The intraspinal lesion is hyperintense on Т2 and iso- to hypointense on Т1, corresponding to an ischemic spinal stroke. The extraspinal lesion is hypointense on all sequences and corresponds to a chronic sSAH. The patient denies traumatic injuries, but is with a history of a regular intake of Acenocumarol for chronic atrial fibrillation. The laboratory investigations at hospital admittance showed that the patient is in a state of hypocoagulability. The applied medications resulted in satisfactory improvement of the neurological symptoms.In our opinion the presented case report is of interest because of the extreme rarity of sSAH, moreover in association with spinal ischemic stroke. The hypocoagualability state is the most probable cause of sSAH, which is later complicated with arterial vasospasm, the latter resulting in spinal ischemic stroke.