Abstract:Subarachnoid hemorrhage and intramedullary hematoma of the spinal axis are rare entities encountered by the neurosurgeon. Causes of spontaneous hemorrhage vary considerably and often pose a diagnostic dilemma for the treating clinician. Vascular malformations, such as arteriovenous malformations, remain the most common source of hemorrhage, and, depending on their location, can present with symptoms similar to cerebral subarachnoid hemorrhage. Sophisticated imaging modalities are often needed in diagnosis, such as selective spinal arteriography and magnetic resonance imaging (MRI). Other causes of spinal axis hemorrhage include spinal artery aneurysms, tumors, and a host of other less common entities. Modern imaging techniques and interventional neuroradiologic and surgical advancements have improved diagnosis and treatment of these complex disorders.