Effects of rehabilitation on spontaneous intramedullary spinal cord hemorrhage (hematomyelia) patient without surgery: A case report

RATIONALE: Spontaneous intramedullary spinal cord hemorrhage (hematomyelia) is a rare disease and most cases have specific etiologies such as cavernous malformations and tumor. Most reported cases are about surgical treatment of intramedullary spinal cord hemorrhage, but there are no reports of rehabilitation effectiveness reported. This case reports the first case with positive effect of rehabilitation on a patient with intramedullary spinal cord hemorrhage, who did not undergo surgery. PATIENT CONCERNS: A 79-year old female visited the department of emergency complaining of sudden-onset back pain, weakness and sensory disturbance in both lower extremities and voiding difficulty. The symptoms started 2 weeks prior to her visit. DIAGNOSES: Whole spine magnetic resonance imaging revealed intramedullary spinal cord hemorrhage at the C7-T3 level and preoperative diagnosis was spinal cavernous malformation. INTERVENTIONS: Since the benefit of surgery was presumed to be low on her, she performed rehabilitation, divided into 2 sessions per day and each session took 30 min. OUTCOMES: After 3 months of rehabilitation, numeric pain rating scale of back pain decreased, and Berg Balance Scale score, Korean version of modified Barthel index score improved. On discharge, she was able to walk independently under supervision and void without Foley catheter. LESSONS: This case suggests that early rehabilitation such as physical therapy is an effective treatment for improving function in patients with intramedullary spinal cord hemorrhage with or without operation