Lumbar traumatic hematomyelia in a young French bulldog

A 2.5-year-old male entire French bulldog was presented with a 1-day history of progressive paraplegia following spinal trauma. Twenty-one hours before presentation, the dog entered a paddock and a horse fell on his back. The owner reported ambulatory paraparesis immediately thereafter, followed by progressive paraplegia over a few hours. Neurological examination revealed paraplegia with intact deep pain perception, absent patellar reflexes, decreased pelvic limb withdrawal reflexes, decreased pelvic limb muscle tone and no apparent spinal pain. A cutaneous trunci reflex cut-off was observed at the mid-lumbar level. A L4-S3 myelopathy was therefore suspected. Serum biochemistry and spinal radiographs were within normal limits. Computed tomography of the spinal cord revealed no significant lesion. Sagittal MRI examination of the T3-S3 spinal segment demonstrated an ill-defined intramedullary T2W hyperintense lesion, extending from the level of L3 to L5, associated with spinal cord enlargement consistent with spinal cord oedema (Fig 1A). At the level of the body of L4, there was a poorly defined, heterogeneous T2W hypointense and T1W slightly hypointense central intramedullary lesion (Fig 1A, B). It appeared as a well-defined, elongated, ovoid, homogeneously hypointense, intramedullary lesion on sagittal T2*W images (Fig 1C). On the T2W transverse images, this lesion showed a symmetrical butterfly-shaped hypointense signal associated with the grey matter surrounded by a hyperintense rim (Fig 1D) with uniform loss of signal on the T2*W images (Fig 1E). There was no contrast enhancement after gadolinium injection. The imaging features were suggestive of lumbar haematomyelia. Coagulation profile (platelets count, prothrombin time and activated partial thromboplastin time) was unremarkable. The dog subsequently improved with appropriate nursing care to become ambulatory after 3 weeks. Normal gait without any observable residual deficits was reported by the owner 2 months after injury. While it remains uncommon, intramedullary haemorrhage should be included in the differential diagnosis of traumatic spinal cord injuries, particularly when clinical signs appear gradually after a traumatic event. In such cases, even if the prognosis remains uncertain, a positive outcome may be achieved with through conservative management.