Central Role of Spinal MRI in Diagnosing Medullary Cavernoma Revealed by Hematomyelia: A Case Report and Literature Review.

Medullary cavernomas are rare vascular malformations of the central nervous system composed of dilated, fragile vessels prone to spontaneous hemorrhage. Although spinal localization is less common than cerebral involvement, bleeding may result in severe neurological deficits and significant morbidity. We report the case of an 85-year-old patient with no major relevant history who presented to the emergency department with acute, intense cervical spinal pain associated with rapidly progressive tetraparesis. Neurological examination revealed marked weakness of all four limbs. Initial laboratory tests were unremarkable. Spinal magnetic resonance imaging demonstrated a cervical intramedullary cavernoma associated with surrounding hematomyelia and local mass effect, confirming the diagnosis of hemorrhagic medullary cavernoma. The patient was referred for multidisciplinary neurosurgical assessment. This case highlights the importance of considering hemorrhagic medullary cavernoma in elderly patients presenting with acute spinal pain and rapid neurological deterioration, and underscores the value of prompt MRI and individualized multidisciplinary evaluation for early diagnosis and management.