Spinal Cord Hematoma Presenting with Gadolinium Enhancement: A Case Study Mimicking Intramedullary Tumor in a Cervical Cord Injury

A bstract This case study addresses a spinal cord hematoma that, due to gadolinium enhancement on magnetic resonance imaging (MRI), was initially mistaken for an intramedullary tumor. It underscores the need for precise differentiation between these conditions to ensure correct diagnosis and treatment. The study reviews the clinical signs, diagnostic difficulties, and management approaches for such cases. An 11-year-old girl experienced sudden spastic quadriparesis after a bicycle fall. MRI showed intramedullary lesions in the cervical spine at the level of C1–C2, with significant swelling and gadolinium enhancement suggesting a possible tumor. Dynamic computed tomography scan suggested a mobile type of atlanto axial dislocation due to os odontodium. After C1–C2 fixation surgery, her neurological function improved significantly. Follow-up MRI indicated that the intramedullary lesions gradually regressed, confirming the initial diagnosis of a spinal cord hematoma rather than a tumor. Spinal cord hematomas can present with gadolinium enhancement and mimic intramedullary tumors, presenting a diagnostic challenge. Awareness of this potential mimicry is essential for clinicians to avoid misdiagnosis and ensure appropriate treatment.