A Sneeze Away From Paralysis: A Unique Case of Spontaneous Spinal Intradural Hematoma

TL;DR

A 72-year-old man developed a rare spinal hematoma after sneezing, showing that non-traumatic events can cause this condition.

Contribution

This case uniquely demonstrates that sneezing can trigger a spinal hematoma without trauma or coagulopathy.

Findings

MRI showed a large spinal hematoma from the pre-pontine cistern to T12, causing cord compression.

The patient recovered motor function without surgery, though urinary retention persisted.

The case emphasizes the need to consider non-traumatic triggers for spinal hematomas.

Abstract

Spontaneous spinal intradural hematomas (SSIH) are exceptionally rare and typically associated with trauma, coagulopathy, or vascular malformations. Even rarer are cases triggered by seemingly benign events such as sneezing.

We report the case of a 72-year-old male who developed acute neurological symptoms following a sneezing episode despite having no prior history of trauma or coagulopathy. The patient presented with a band-like pain localized to the periumbilical region and caudal hypesthesia, persisting for one week.

Spinal MRI revealed an extensive intradural hematoma extending from the pre-pontine cistern to T12, predominantly along the ventral and dorsal aspects of the spinal cord. This hematoma caused significant cord compression and signs of myelopathy on the dorsal segment. Remarkably, the patient recovered full lower limb motor function through conservative management without requiring surgical intervention. However, intermittent self-catheterization remained necessary due to persistent urinary retention, likely multifactorial in origin.

This case highlights the importance of considering non-traumatic events such as sneezing as potential triggers for SSIH, even in the absence of classical risk factors, and underlines the value of individualized, imaging-guided management approaches. A literature review further highlights the rarity of such presentations and underscores the need for continued investigation into their underlying pathophysiology.

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