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Spinal cavernous malformations are rare vascular anomalies that account for 5% of all cavernous malformations and 5-12% of all intraspinal vascular malformations. When symptomatic, these can mimic tumors and inflammatory myelopathies, yet there are few known risk factors for solitary spinal cavernomas. Here we report a rare case of a spinal cord cavernoma with symptom onset after strenuous weightlifting.

This is a case report with relevant neuroimaging findings. Consent was obtained for this study.

A 45-year-old right-handed man presented with four days of low back pain after strenuous powerlifting. Further examination revealed urinary retention, fecal retention, weakness and hyporeflexia in his right lower leg, and no associated sensory deficits. At presentation, MRI of his lumbar spine was unremarkable. Due to initial concern for transverse myelitis, the patient was treated empirically with IV methylprednisolone, without improvement, and a lumbar puncture was completed. Serum and CSF studies for Lyme disease, sarcoidosis, and multiple sclerosis were unremarkable. A repeat MRI of his thoracic spine demonstrated a central intensity between T7-T10 and an 8 mm nodule at T10, suggesting an intramedullary cavernous malformation with a hemorrhage. This patient was managed conservatively with a follow-up MRI planned in three months. Subsequently, he was transitioned to inpatient physical medicine and rehabilitation and regained mobility and continence prior to discharge.

Spinal cord cavernomas can present with acute hemorrhage after strenuous weightlifting. This should be considered in the differential when presented with signs and symptoms of transverse myelitis.