Spinal intramedullary cavernomas are a relatively rare entity and these natural histories concerning hemorrhage rates are unknown. The authors report a case of thoracic intramedullary cavernoma with recurrent hemorrhage in a short interval from initial hemorrhage and discuss the timing of surgery for this lesion. A 27-years old woman was admitted because of rapid progressive myelopathy of bilateral lower extremities. MR images of the thoracic spine demonstrated an intramedullary hemorrhagic lesion at the T-9 level. Nine days later, she became sudden-onset paraparesis during menses. MRI demonstrated new hemorrhage at the T6-T9 level. Although she underwent total resection of the cavernoma with intramedullary hemorrhage, her neurological deficits did not recover at all. In patients with spinal cavernoma demonstrating symptomatic hemorrhage, early surgical intervention should be taken into consideration to prevent catastrophic outcome.
